Individual provider Active NPI

Kimberly Dawn Swanner, DNP, AGACNP-BC

  • Acute Care Nurse Practitioner
  • Memphis, TN
National Provider Identifier
1164057865
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
32091 Issued in TN
Practice address
877 Jefferson Ave
Memphis, TN 38103-2807
Phone
(901) 545-7100
NPI assigned
Mar 3, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 880120 MS
Acute Care Nurse Practitioner 363LA2100X 905370 MS
Acute Care Nurse Practitioner 363LA2100X 32091 TN Primary

Addresses

Primary practice location

877 Jefferson Ave
Memphis, TN 38103-2807

Mailing address

5879 Highway 315
Water Valley, MS 38965-3043
Phone (662) 607-7077

Other practice location 1

504 Azalea Dr Ste A
Oxford, MS 38655-5397
Phone (662) 636-4320

Other practice location 2

504 Azalea Dr Ste A
Oxford, MS 38655-5397
Phone (662) 636-4320

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221107001837 TN Practitioner - Nurse Practitioner 0143697060
I20240924004532 MS Practitioner - Nurse Practitioner 0143697060 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
80.97 of 100Reported as group
Quality
64.58
Improvement activities
40
Cost
77.33

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
880120MSMDRegistered Nurse
905370MSMDAcute Care Nurse Practitioner
32091TNMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Relias Emergency Medicine Specialists of Amory, LLC CurrentSince Jul 1, 2024 Accepting new patients
Relias Hospitalist Medicine Specialists of Amory LLC CurrentSince Jun 28, 2024 Accepting new patients
Relias Clinical Decision Specialists of Hattiesburg, LLC CurrentSince Aug 22, 2024 Accepting new patients

Locations

1105 Earl Frye Blvd
Amory, MS 38821
Phone (662) 256-7111

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666742400000",
    "number": "1164057865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5879 HIGHWAY 315",
            "city": "WATER VALLEY",
            "state": "MS",
            "postal_code": "389653043",
            "telephone_number": "662-607-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 JEFFERSON AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381032807",
            "telephone_number": "901-545-7100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "504 Azalea Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "MS",
            "postal_code": "386555397",
            "country_code": "US",
            "telephone_number": "662-636-4320",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "504 Azalea Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "MS",
            "postal_code": "386555397",
            "country_code": "US",
            "telephone_number": "662-636-4320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SWANNER",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "name_prefix": "Dr.",
        "credential": "DNP,  AGACNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-03",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "880120",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "905370",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "TN",
            "license": "32091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.