Provider Demographics
NPI:1548339369
Name:VINCENT, KIMBERLY DAWN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAWN
Last Name:VINCENT
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:24 WHITE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-1411
Practice Address - Country:US
Practice Address - Phone:615-352-0011
Practice Address - Fax:615-352-1752
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ026765Medicaid
TN6039681OtherBCBS TN
TNG57261Medicare UPIN
TNQ026765Medicaid