1225070337 NPI number — KIMBERLY RAE FELTS FNP

Table of content: KIMBERLY RAE FELTS FNP (NPI 1225070337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225070337 NPI number — KIMBERLY RAE FELTS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELTS
Provider First Name:
KIMBERLY
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARVER
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225070337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 381468
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38183-1468
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-737-4665
Provider Business Mailing Address Fax Number:
901-328-1355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 S HARTMANN DR STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37090-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-885-1093
Provider Business Practice Location Address Fax Number:
615-885-1110
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN0000108974 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 7321 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q010574 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6033858 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".