Provider Demographics
NPI:1871255174
Name:CRAIN, KIMBERLY ANN
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:CRAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 RABBIT TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:LEOMA
Mailing Address - State:TN
Mailing Address - Zip Code:38468-5652
Mailing Address - Country:US
Mailing Address - Phone:931-629-1963
Mailing Address - Fax:
Practice Address - Street 1:482 RABBIT TRAIL RD
Practice Address - Street 2:
Practice Address - City:LEOMA
Practice Address - State:TN
Practice Address - Zip Code:38468-5652
Practice Address - Country:US
Practice Address - Phone:931-629-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000161406207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty