Provider Demographics
NPI:1376195594
Name:BOONE, KIMBERLY AFTON (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:AFTON
Last Name:BOONE
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 1:1350 CONCOURSE AVE STE 142
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4570
Mailing Address - Country:US
Mailing Address - Phone:901-701-2032
Mailing Address - Fax:907-722-8078
Practice Address - Street 1:1350 CONCOURSE AVE STE 142
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-4570
Practice Address - Country:US
Practice Address - Phone:901-272-0003
Practice Address - Fax:907-722-8078
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3191133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered