Provider Demographics
NPI:1487276796
Name:LOPEZ CLEMENTE, KIMBERLY ZUHAYL
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ZUHAYL
Last Name:LOPEZ CLEMENTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33150-1015
Mailing Address - Country:US
Mailing Address - Phone:340-332-5025
Mailing Address - Fax:
Practice Address - Street 1:1410 SPARTA ST STE 6
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1376
Practice Address - Country:US
Practice Address - Phone:931-474-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLE173333207Q00000X
TN75143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine