KIMBERLY ANNE TATUM, N.P. - NPI NUMBER 1366704488

Summary

Provider Name: KIMBERLY ANNE TATUM, N.P.

NPI Number: 1366704488

Clasification: Nurse Practitioner (363L00000X)

Organization: FORSYTH MEMORIAL HOSPITAL., INC.

Address:
1941 NEW GARDEN RD
SUITE 216
GREENSBORO, NC
ZIP 27410

Phone Number: (336) 288-8857



Detailed Information

Kimberly Anne Tatum, N.P. is a nurse practitioner in Greensboro, NC with 2 years of experience. The provider is (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. The assigned NPI number for this provider is 1366704488 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

1941 NEW GARDEN RD
SUITE 216
GREENSBORO, NC
ZIP 27410-554
Phone: (336) 288-8857
Fax: (336) 288-8769

The enumeration date for this NPI number is 6/14/2012 and was last updated on 9/10/2014.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363L00000X Nurse Practitioner 5005656 NC Yes
2 363LF0000X Nurse Practitioner Family 5005656 NC No

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 NC7468A MEDICARE PIN NC
2 7006143 MEDICAID NC

NPI Record

No. Field Name Field Value
1 NPI 1366704488
2 Entity Type Code 1
3 Provider Last Name Legal Name TATUM
4 Provider First Name KIMBERLY
5 Provider Middle Name ANNE
6 Provider Credential Text N.P.
7 Provider First Line Business Practice Location Address 1941 NEW GARDEN RD
8 Provider Second Line Business Practice Location Address SUITE 216
9 Provider Business Practice Location Address City Name GREENSBORO
10 Provider Business Practice Location Address State Name NC
11 Provider Business Practice Location Address Postal Code 274102554
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 3362888857
14 Provider Business Practice Location Address Fax Number 3362888769
15 Provider Enumeration Date 6/14/2012
16 Last Update Date 9/10/2014
17 Provider Gender Code F
18 Healthcare Provider Taxonomy Code 1 363L00000X
19 Provider License Number 1 5005656
20 Provider License Number State Code 1 NC
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Healthcare Provider Taxonomy Code 2 363LF0000X
23 Provider License Number 2 5005656
24 Provider License Number State Code 2 NC
25 Healthcare Provider Primary Taxonomy Switch 2 N
26 Other Provider Identifier 1 NC7468A
27 Other Provider Identifier Type Code 1 08
28 Other Provider Identifier State 1 NC
29 Other Provider Identifier 2 7006143
30 Other Provider Identifier Type Code 2 05
31 Other Provider Identifier State 2 NC
32 Is Sole Proprietor N

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.