Provider Demographics
NPI:1235965534
Name:HERRMANN, KIMBERLEE SNELL
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:SNELL
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 BENTBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-6020
Mailing Address - Country:US
Mailing Address - Phone:901-395-4155
Mailing Address - Fax:
Practice Address - Street 1:10560 BENTBROOKE DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:TN
Practice Address - Zip Code:38002-6020
Practice Address - Country:US
Practice Address - Phone:901-395-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNORT0000000231222Z00000X
TNPRO0000000226224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist