Provider Demographics
NPI:1841581261
Name:PRESTON, KIMBERLY WORMER (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WORMER
Last Name:PRESTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-423-8697
Mailing Address - Fax:731-423-2073
Practice Address - Street 1:68 EXETER RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1829
Practice Address - Country:US
Practice Address - Phone:731-422-0213
Practice Address - Fax:731-868-4871
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2025-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15404363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1523473Medicaid
TNP00938202Medicare PIN
TN1523473Medicaid