Individual
MRS. KIMBALL JANE-MARIE SARGENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, PMHCNS-BC
Contact information
Practice address
7155 SUNSET LAKE RD, FUQUAY VARINA, NC 27526-8638
(919) 838-0804
(919) 838-1219
Mailing address
7155 SUNSET LAKE RD, FUQUAY VARINA, NC 27526-8638
(919) 838-0804
(919) 838-1219
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
080028
NC
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
080028
NC
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Primary
0261495-01
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10079
BCBS PROVIDER #
NC
01
—
232289
COMPSYCH CORP. PROV #
NC
01
—
527619
VALUE OPTIONS MHS #
NC
05
—
6004025
—
NC
01
—
C 2802004
UNITEDAMER.INS.CO. PROV #
NC
Enumeration date
05/28/2006
Last updated
01/13/2019
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