Provider Demographics
NPI:1083044226
Name:GRIFFIN, KIMBERLY WINTERS
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WINTERS
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 TARRY PARK
Mailing Address - Street 2:APT1
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2060
Mailing Address - Country:US
Mailing Address - Phone:901-315-6389
Mailing Address - Fax:
Practice Address - Street 1:4100 TARRY PARK APT1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118
Practice Address - Country:US
Practice Address - Phone:901-315-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00128578376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide