Kimberly Anne Tatum, N.P.

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5005656 Issued in NC

Practice address

4125 Lawndale Dr
Greensboro, NC 27455-1885

Phone

(336) 543-0786

Fax

(336) 234-5411

NPI assigned

Jun 14, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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 1

Specialty

Nurse Practitioner

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Elizabeth Dewey MDGroup PAC ID 7416206644, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kimberly.tatum@182105165529092.direct.elationemr.com

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.

• Elizabeth Dewey MD

  • Family Medicine Physician
  • Greensboro, NC
  • NPI 1932652807
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694390400000",
    "number": "1366704488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 JUNIPER CREEK BLVD",
            "city": "PINEHURST",
            "state": "NC",
            "postal_code": "283746819",
            "telephone_number": "330-416-3833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 LAWNDALE DR",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274551885",
            "telephone_number": "336-543-0786",
            "fax_number": "336-234-5411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "608 Dawson St Ste 103",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284015712",
            "country_code": "US",
            "telephone_number": "910-387-3745",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "608 Dawson St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284015712",
            "country_code": "US",
            "telephone_number": "910-387-3788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TATUM",
        "first_name": "KIMBERLY",
        "middle_name": "ANNE",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-14",
        "last_updated": "2023-09-11",
        "certification_date": "2023-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5005656",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5005656",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7006143",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lashonda Trenise Tate
• Latoya Celeste Tate
• Regina Denise Tate, RESIDENTIAL CARE
• Iymanii Tatem
• Athena Lucia Tatum, LCSW, MSW, MPA
• Tawana W. Barrow, MD, PLLC
• Roya Tawkaliyar, DO
• Alexis Tay
• Hyacinth Taylor Taylor-Hampton, RN
• Anna Taylor, M.ED

• Nurse Practitioner in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.