MEDICARE: KIMBERLY D PATTERSON

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	879194	NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	29794	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952972606
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY D PATTERSON

Provider Business Mailing Address
First Line	:	5652 CLARKE CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-3502
Country	:	US
Telephone Number	:	901-691-2773
Fax Number	:

Provider Business Practice Location Address
First Line	:	5652 CLARKE CV
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38115-3502
Country	:	US
Telephone Number	:	901-729-9243
Fax Number	:

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

Provider Enumeration Date	:	07/04/2021
Last Update Date	:	03/10/2026

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Directions to “ KIMBERLY D PATTERSON ” Practice Location

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