Provider Demographics
NPI:1922002336
Name:HOWERTON, KIMBERLY ANN (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:HOWERTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 SECURITY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3754
Mailing Address - Country:US
Mailing Address - Phone:731-215-2888
Mailing Address - Fax:731-215-2752
Practice Address - Street 1:25 SECURITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3754
Practice Address - Country:US
Practice Address - Phone:731-215-2888
Practice Address - Fax:731-215-2752
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4105358OtherBLUE CROSS BLUE SHIELD
TN6391611OtherCIGNA
TN3850931Medicaid
TN626001636OtherHEALTH PARTNERS
TN39401OtherTLC
TN626001636OtherUNITED HEALTHCARE
TN626001636OtherUSA MANAGED CARE
TN168928OtherUNISON
TN626001636OtherUNITED HEALTHCARE
TN3850931Medicaid