Provider Demographics
NPI:1861723066
Name:THOMAS, KIMBERLY A (CFNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-3708
Mailing Address - Country:US
Mailing Address - Phone:615-695-1455
Mailing Address - Fax:615-695-1483
Practice Address - Street 1:1750 MEMORIAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6356
Practice Address - Country:US
Practice Address - Phone:931-245-2086
Practice Address - Fax:931-245-2087
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN82423363LF0000X
TNAPN6394363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4265147OtherBLUE CROSS OF TN
TN1517675OtherMEDICAID GROUP NUMBER
TN3904561Medicaid
TN4259723OtherBLUE CROSS OF TN GROUP NUMBER