Individual
MRS. KIMBERLY RANDALL BOOKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM, WHNP-BC
Contact information
Practice address
520 MAPLE AVE, SUITE C, REIDSVILLE, NC 27320-4652
(336) 342-6063
(336) 342-6066
Mailing address
3871 VANCE STREET EXT, REIDSVILLE, NC 27320-8873
(336) 613-0904
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
BOO104379455
NC
367A00000X
Advanced Practice Midwife
Primary
522
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013359934
—
NC
01
—
1799G
BCBS
—
01
—
Q44206A
MEDICARE INDIVIDUAL PTAN LINKED TO FACULTY PRACTICE GROUP
—
Enumeration date
07/19/2013
Last updated
08/11/2021
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