Provider Demographics
NPI:1386842862
Name:KIM, JENNIFER L (APRN, BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:KIM
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 FIRST HALL
Mailing Address - Street 2:46121ST AVENUE SOUTH
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37240-0001
Mailing Address - Country:US
Mailing Address - Phone:615-936-0736
Mailing Address - Fax:615-936-0228
Practice Address - Street 1:370 FIRST HALL
Practice Address - Street 2:46121ST AVENUE SOUTH
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37240-0001
Practice Address - Country:US
Practice Address - Phone:615-936-0736
Practice Address - Fax:615-936-0228
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN7512363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNAPN7512OtherADVANCED PRACTICE LICENSE