Provider Demographics
NPI:1992287254
Name:ALSTON, KIMBERLY DUPREE (CPM-TN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DUPREE
Last Name:ALSTON
Suffix:
Gender:F
Credentials:CPM-TN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 CIRCLE GATE DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-8105
Mailing Address - Country:US
Mailing Address - Phone:901-315-0835
Mailing Address - Fax:
Practice Address - Street 1:2123 S GERMANTOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3865
Practice Address - Country:US
Practice Address - Phone:901-315-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty