Provider Demographics
NPI:1427271766
Name:CRUTCHER, KIMBERLY D (RN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:CRUTCHER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:TN
Mailing Address - Zip Code:37058-3302
Mailing Address - Country:US
Mailing Address - Phone:931-232-5329
Mailing Address - Fax:931-232-7247
Practice Address - Street 1:1021 SPRING ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:TN
Practice Address - Zip Code:37058-3302
Practice Address - Country:US
Practice Address - Phone:931-232-5329
Practice Address - Fax:931-232-7247
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77852163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN77852OtherRN