KIMBERLY TANNER FAVA (NPI# 1215195631) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215195631 |
| Entity Type | Individual |
| Full Name | KIMBERLY TANNER FAVA |
| Credential | WHCNP, APRN |
| Practice Address |
2000 N State St Clarksdale MS 38614-6100 |
| Practice Telephone | 6626277361 |
| Practice Fax Number | 6626271158 |
| Mailing Telephone | 6626277361 |
| Mailing Fax Number | 6626271158 |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2010-03-04 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LX0001X |
Nurse Practitioner Specialization: Obstetrics & Gynecology |
R854373 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 3459830 | 05 |
| Street Address |
2000 N STATE ST |
| City | CLARKSDALE |
| State | MS |
| Zip Code | 38614-6100 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346233442 | Bouldin A Marley Jr. | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-08-24 |
| 1346735057 | Teresa Victoria White Powell | Nurse Practitioner | 2000 N State St, Clarksdale, MS 38614-6100 | 2018-06-25 |
| 1477898112 | Woman's Clinic, A Professional Association | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2012-12-06 |
| 1629293113 | Frank T. Marascalco, M.d., P.a. | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2007-04-17 |
| 1730104928 | Delphia M Hord | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2006-07-12 |
| 1982690061 | Linda D Wright | Nurse Practitioner | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-09-23 |
| 1366438772 | Erica R Balthrop | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-09-21 |
| 1861488215 | Kushna K Damallie | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-09-21 |
| 1043203136 | Womans Clinic, A Professional Association | Specialist | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-08-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386265627 | Lillie Mae Lockett | Technician | 1025 Ritchie Ave, Clarksdale, MS 38614 | 2020-04-28 |
| 1063957751 | Autospa-healthy Youth Center | Nurse Practitioner | 1202 Desoto Ave, Suite A, Clarksdale, MS 38614 | 2017-01-04 |
| 1700226123 | Nikki Nikkia Cager | Internal Medicine | 785 Ohio Ave Ste 2d, Clarksdale, MS 38614 | 2013-06-29 |
| 1205186947 | Celestial Comfort Care Hospice | Hospice Care, Community Based | 110 Yazoo Ave. Suite 212, Clarksdale, MS 38614 | 2012-09-10 |
| 1063667129 | The Smile Center of Clarksdale | Clinic/Center | 526 Choctaw Street, Suites B & C, Clarksdale, MS 38614 | 2008-11-17 |
| 1801060033 | Clarksdale Municipal School District | Local Education Agency (LEA) | Gycelle Tynes Educational Center, Friars Point Road, Clarksdale, MS 38614 | 2008-04-18 |
| 1184806150 | Mary A Williams | Nurse Practitioner | 125 Highway 322, Clarksdale, MS 38614 | 2007-12-03 |
| 1114040367 | William F Wilson Jr. | Dentist | 850 Desoto Ave, Extended, Clarksdale, MS 38614 | 2007-04-10 |
| 1952434920 | Kathleen Tinnel | Nurse Practitioner | 2245 N State St, Clarksdale, MS 38614 | 2007-03-13 |
| 1497888457 | Carole L Mangrem | Pediatrics | 2245 N Starte St, Clarksdale, MS 38614 | 2007-03-13 |
| Find all providers in zip 38614 | ||||
| Taxonomy Code | 363LX0001X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Obstetrics & Gynecology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982690061 | Linda D Wright | Nurse Practitioner | 2000 N State St, Clarksdale, MS 38614-6100 | 2005-09-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1669762902 | Stacey Marie Kreher | Nurse Practitioner | 1009 Benigno Ln., Hancock Women's Center, Bay St. Louis, MS 39520 | 2011-04-07 |
| 1174755359 | Innovative Health LLC | Nurse Practitioner | 501 Marshall St Ste 605, Jackson, MS 39202-1650 | 2009-08-20 |
| 1891814802 | Delta Physician Practices | Nurse Practitioner | 302 Arnold Ave, Greenville, MS 38701-4711 | 2007-03-29 |
| 1629116330 | Jean Lawes | Nurse Practitioner | 701 Yalobusha St, Greenwood, MS 38930-2015 | 2007-02-02 |
| 1669450425 | Melissa L Barnett | Nurse Practitioner | 1793 Cliff Gookin Blvd, Tupelo, MS 38801-6723 | 2006-01-03 |
| 1831619626 | Erica Clanahan | Nurse Practitioner | 2124 14th St, Meridian, MS 39301-4040 | 2017-06-22 |
| 1699157487 | Jada Elyse Vierling Hill | Nurse Practitioner | 715a Division St, Biloxi, MS 39530-2209 | 2015-06-29 |
| 1396017646 | Mary K Fouquier | Nurse Practitioner | 1207 N West St, Jackson, MS 39202-2018 | 2012-02-02 |
| 1407157118 | Carolann Risley | Nurse Practitioner | 4600 Vega St, Pascagoula, MS 39581-5303 | 2010-11-11 |
| Find all providers with the same taxonomy | ||||
| City | CLARKSDALE |
| Zip Code | 38614 |
Please comment or provide details below to improve the information on KIMBERLY TANNER FAVA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.