Provider Demographics
NPI:1396792057
Name:WOMBACK RICE, KIMBERLY FELICIA (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:FELICIA
Last Name:WOMBACK RICE
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 1:8951 GOLF WALK CIR S
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-8910
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8951 GOLF WALK CIR S
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-8910
Practice Address - Country:US
Practice Address - Phone:901-230-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37227207P00000X
MS19047207P00000X
ARE-7028207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4112805OtherBLUE CROSS
TN33421OtherTLC TENNCARE
MS02358211Medicaid
MS02358211Medicaid
TN33421OtherTLC TENNCARE
MS930003577Medicare ID - Type Unspecified