Provider Demographics
NPI:1457316630
Name:PERRY, KIMBERLY ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:PERRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3651 TULLAHOMA HWY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398-4940
Mailing Address - Country:US
Mailing Address - Phone:931-962-4082
Mailing Address - Fax:931-962-4084
Practice Address - Street 1:3651 TULLAHOMA HWY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-4940
Practice Address - Country:US
Practice Address - Phone:931-962-4082
Practice Address - Fax:931-962-4084
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6754363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724619Medicaid
TN3724619OtherRAILROAD MEDICARE
TN3724619OtherMEDICARE GRP PIN
TN3724619OtherMEDICARE GRP PIN
TNS11830Medicare UPIN