Provider Demographics
NPI:1922388727
Name:CATLIN, KIMBERLY (NP,)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CATLIN
Suffix:
Gender:F
Credentials:NP,
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:DREWREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP,
Mailing Address - Street 1:PO BOX 1022
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:38485-1022
Mailing Address - Country:US
Mailing Address - Phone:931-722-2369
Mailing Address - Fax:
Practice Address - Street 1:1600 US HIGHWAY 79 S
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75654-4508
Practice Address - Country:US
Practice Address - Phone:903-717-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1103A363LF0000X
TXAP136629363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX385624701OtherMEDICAID
TX645563OtherMEDICARE
TX8JE110OtherBCBS
TXP02020896OtherMEDICARE RAIL ROAD