Provider Demographics
NPI:1194186387
Name:CARTER, KIMBERLY (PT, NCS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:CARTER
Suffix:
Gender:F
Credentials:PT, NCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 MADISON AVE
Mailing Address - Street 2:ROOM 658
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38163-2243
Mailing Address - Country:US
Mailing Address - Phone:901-448-5888
Mailing Address - Fax:901-448-1411
Practice Address - Street 1:930 MADISON AVE
Practice Address - Street 2:ROOM 658
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-2243
Practice Address - Country:US
Practice Address - Phone:901-448-5888
Practice Address - Fax:901-448-1411
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39502251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446645Medicaid
TN3133295OtherBLUE CROSS BLUE SHIELD OF TN
TN3133295OtherBLUE CROSS BLUE SHIELD OF TN