Provider Demographics
NPI:1225070337
Name:FELTS, KIMBERLY RAE (FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RAE
Last Name:FELTS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:RAE
Other - Last Name:CARVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2020 EXETER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:920 S HARTMANN DR STE 310
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-4137
Practice Address - Country:US
Practice Address - Phone:615-885-1093
Practice Address - Fax:156-885-1110
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7321363LF0000X
TNRN0000108974363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010574Medicaid
TN6033858OtherBLUE CROSS/BLUE SHIELD
TN6033858OtherBLUE CROSS/BLUE SHIELD
TNP90851Medicare UPIN