Provider Demographics
NPI:1831148683
Name:MCGOWAN, KIMBERLY K (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:CARRELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1800 MEDICAL CENTER PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-2567
Mailing Address - Country:US
Mailing Address - Phone:615-907-2040
Mailing Address - Fax:615-907-2827
Practice Address - Street 1:1800 MEDICAL CENTER PKWY
Practice Address - Street 2:SUITE 350
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2567
Practice Address - Country:US
Practice Address - Phone:615-907-2040
Practice Address - Fax:615-907-2827
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30765207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3829895Medicaid
TN3829895Medicaid
TNG82942Medicare UPIN