Provider Demographics
NPI:1154910230
Name:ZIMMERMAN, KRISTIE (NP)
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ATCHISON RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38256-6455
Mailing Address - Country:US
Mailing Address - Phone:731-363-0724
Mailing Address - Fax:
Practice Address - Street 1:301 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1512
Practice Address - Country:US
Practice Address - Phone:931-299-7378
Practice Address - Fax:931-299-7399
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN28102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily