MEDICARE: DR. KIM CLOVER EDD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor
2	101YP2500X	Professional Counselor	472	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	103856	OTHER	TN	VALUE OPTIONS TRICARE

General Provider Information

NPI Number	:	1811191950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIM CLOVER EDD

Provider Business Mailing Address
First Line	:	6551 STAGE OAKS DR STE 4
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-387-0026
Fax Number	:	901-552-4737

Provider Business Practice Location Address
First Line	:	6551 STAGE OAKS DR STE 4
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-387-0026
Fax Number	:	901-552-4737

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	02/22/2022

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Directions to “ DR. KIM CLOVER EDD” Practice Location

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