Provider Demographics
NPI:1427792340
Name:KIMBERLIN, BRENNAN WHEELER (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRENNAN
Middle Name:WHEELER
Last Name:KIMBERLIN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S GERMANTOWN RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2205
Mailing Address - Country:US
Mailing Address - Phone:901-759-5443
Mailing Address - Fax:901-435-5665
Practice Address - Street 1:7887 WOLF RIVER BLVD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1718
Practice Address - Country:US
Practice Address - Phone:901-759-5443
Practice Address - Fax:901-435-5665
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ076776Medicaid