Provider Demographics
NPI:1023456993
Name:SAMS, KIMBERLY ANN (MS, CCC-A/SLP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANN
Last Name:SAMS
Suffix:
Gender:F
Credentials:MS, CCC-A/SLP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LANGLEY
Other - Last Name:SNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-A/SLP
Mailing Address - Street 1:65 RIDGECREST RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2359
Mailing Address - Country:US
Mailing Address - Phone:731-668-6076
Mailing Address - Fax:731-668-7033
Practice Address - Street 1:65 RIDGECREST RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2359
Practice Address - Country:US
Practice Address - Phone:731-668-6076
Practice Address - Fax:731-668-7033
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1065231H00000X, 237600000X
TN000286180235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter