Provider Demographics
NPI:1689668105
Name:NEAL, KIMERLY A (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMERLY
Middle Name:A
Last Name:NEAL
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 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:615-284-4088
Mailing Address - Fax:615-284-7501
Practice Address - Street 1:401 SEWELL DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:TN
Practice Address - Zip Code:38583-1223
Practice Address - Country:US
Practice Address - Phone:931-738-4395
Practice Address - Fax:931-738-4330
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005782363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4137186OtherBC/BS TN - MCMINNVILLE
TN3905395Medicaid
TN4139731OtherBC/BS TN - CROSSVILLE
TN3905395Medicare PIN
TN3905395Medicaid