Basic Information
Provider Information
NPI: 1003298100
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOWE
FirstName: KIMBERLY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 228 SOUTH CLAYBROOK
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381043537
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 595 HURRICANE SHOALS RD NW STE 100
Address2:  
City: LAWRENCEVILLE
State: GA
PostalCode: 30046
CountryCode: US
TelephoneNumber: 4046457150
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/24/2015
LastUpdateDate: 08/15/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAPN0000020054TNN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LF0000XRN243783GAN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LG0600XRN243783GAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology

No ID Information.


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