Tatum, Kimberly Modena

Tatum, Kimberly Modena is an sole proprietor health care provider with primary practice located at 4002 S Loop 256 Ste A , Palestine TX 75801-8492. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Tatum, Kimberly Modena can be contacted via phone (903) 731-5030.

Contact Information

Primary practice address
4002 S Loop 256 Ste A Palestine TX 75801-8492
Phone: (903) 731-5030
Fax: (903) 731-5037
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X AP136159 Texas
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X AP136159 Texas
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 9471546 Florida
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X AP136159 Texas

Profile Details

NPI number 1518479542
LBN Legal business name Tatum, Kimberly Modena
Credentials NURSE PRACTITIONER
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 31st, 2017
Last updated Jun 4th, 2024 - about 5 months ago

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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