Provider Demographics
NPI:1336285246
Name:NESBITT, KIMBERLY K (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:K
Last Name:NESBITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 HARBOR VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-1554
Mailing Address - Country:US
Mailing Address - Phone:615-604-7922
Mailing Address - Fax:
Practice Address - Street 1:8900 DELTA BLUFF CV
Practice Address - Street 2:
Practice Address - City:WALLS
Practice Address - State:MS
Practice Address - Zip Code:38680-4400
Practice Address - Country:US
Practice Address - Phone:662-510-4660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN303242083A0300X, 207L00000X
MS255902083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06435820Medicaid
TN3101380OtherBCBS
TN3833877Medicaid
TN3833877Medicare PIN