Provider Demographics
NPI:1164744090
Name:NORWOOD, KIMBERLY KAYE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:KAYE
Last Name:NORWOOD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:KAY
Other - Last Name:THARPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5683 S REX RD STE A
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3821
Mailing Address - Country:US
Mailing Address - Phone:901-350-0678
Mailing Address - Fax:901-350-0677
Practice Address - Street 1:1720 E REELFOOT AVE STE 200
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:TN
Practice Address - Zip Code:38261-6049
Practice Address - Country:US
Practice Address - Phone:731-507-0272
Practice Address - Fax:731-507-0273
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN14751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0905OtherGROUP (PTAN )
TN1519877Medicaid
TN103I502866OtherMEDICARE (PTAN)
TN1519877Medicaid