Kimberly Dawn Polk, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

14737 Issued in TN

Practice address

1325 Eastmoreland Ave
Ste 550
Memphis, TN 38104-7507

Phone

(901) 726-0843

Fax

(901) 278-2695

NPI assigned

Feb 11, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Miss Kimberly Dawn Shannon Former name

Medicare fee-for-service enrollment

Enrolled in TN

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, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Office of Internal Medicine, PCGroup PAC ID 5193860385, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beacon Home Health Home health agency, Memphis, TN, CCN 447277
• Methodist Hospitals of Memphis Hospital, Memphis, TN, CCN 440049
• Methodist Healthcare - Olive Branch Hospital Hospital, Olive Branch, MS, CCN 250167

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpolk28793@mlh.direct-ci.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.

• Office of Internal Medicine, PC

  • Internal Medicine Physician
  • Memphis, TN
  • NPI 1679776678
  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Amedisys Tennessee, LLC

  • Home Health Agency
  • Memphis, TN
  • NPI 1114975539
  Care Compare affiliation
• Methodist Healthcare - Memphis Hospitals

  • Children's Hospital
  • Memphis, TN
  • NPI 1386709871
  Care Compare affiliation
• Methodist Healthcare - Memphis Hospitals

  • General Acute Care Hospital
  • Memphis, TN
  • NPI 1558365890
  Care Compare affiliation
• Methodist Healthcare - Memphis Hospitals

  • Children's Hospital
  • Germantown, TN
  • NPI 1649654450
  Care Compare affiliation
• Methodist Healthcare - Olive Branch Hospital

  • General Acute Care Hospital
  • Olive Branch, MS
  • NPI 1912341439
  Care Compare affiliation

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

{
    "created_epoch": "1265846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408579200000",
    "number": "1730411059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000 DEPT 941",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381010941",
            "telephone_number": "901-726-0843",
            "fax_number": "901-278-2695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 EASTMORELAND AVE",
            "address_2": "STE 550",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381047507",
            "telephone_number": "901-726-0843",
            "fax_number": "901-278-2695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLK",
        "first_name": "KIMBERLY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-11",
        "last_updated": "2014-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "14737",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1518648",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00873632",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "SHANNON",
            "middle_name": "DAWN",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jason Poletti
• Kelly Ann Polivka, DPT
• Temesha Evette Polk-Howard, MSW,LCSW
• Angela Mi Polk
• Erica Polk, D.D.S.
• Lakesha Polk, HAIR LOSS SPECIALIST
• Lakesha Deshun Polk, FNP-C
• Russell Buchanan Polk
• Jessica Chelsea Pollack
• Joseph V Pollack, MD

• Family Nurse Practitioner in Memphis, TN
• Providers in Memphis, TN by specialty
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2014; 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.