Provider Demographics
NPI:1912156696
Name:GREGORY, KIMBERLY D (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:GREGORY
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 NEW MIDDLETON HWY
Mailing Address - Street 2:STE A
Mailing Address - City:GORDONSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38563
Mailing Address - Country:US
Mailing Address - Phone:615-735-8008
Mailing Address - Fax:
Practice Address - Street 1:8 NEW MIDDLETON HWY
Practice Address - Street 2:STE A
Practice Address - City:GORDONSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38563
Practice Address - Country:US
Practice Address - Phone:615-735-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ027166Medicaid