Provider Demographics
NPI:1457036451
Name:SMITH, KIMBERLEY (CCMA)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:CCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 POWELL PLACE
Mailing Address - Street 2:P.O BOX 1052
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3602
Mailing Address - Country:US
Mailing Address - Phone:615-504-9058
Mailing Address - Fax:
Practice Address - Street 1:41 PEABODY ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37210-2125
Practice Address - Country:US
Practice Address - Phone:615-485-7690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy