Fava, Kimberly Tanner

Fava, Kimberly Tanner is an individual health care provider with primary practice located at 2000 N State St , Clarksdale MS 38614-6100. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Fava, Kimberly Tanner can be contacted via phone (662) 627-7361.

Contact Information

Primary practice address
2000 N State St Clarksdale MS 38614-6100
Phone: (662) 627-7361
Fax: (662) 627-1158
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Obstetrics & Gynecology 363LX0001X R854373 Mississippi
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X R854373 Mississippi

Profile Details

NPI number 1215195631
LBN Legal business name Fava, Kimberly Tanner
Credentials WHCNP, APRN
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2008
Last updated Jan 11th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215195631 NPPES
Mississippi MEDICAID 3459830

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