Provider Demographics
NPI:1467711655
Name:CARVER, KIMBERLEY L (CRNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:L
Last Name:CARVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 HIGHWAY 69 S STE C
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-8784
Mailing Address - Country:US
Mailing Address - Phone:205-349-1040
Mailing Address - Fax:205-349-4015
Practice Address - Street 1:7700 HIGHWAY 69 S STE C
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-8784
Practice Address - Country:US
Practice Address - Phone:205-349-1040
Practice Address - Fax:205-349-4015
Is Sole Proprietor?:No
Enumeration Date:2012-05-09
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-071306363L00000X
AL1071306363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1071306OtherLICENSE
AL163616Medicaid