Individual
KIMBERLY JEAN LIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1225 LEWISVILLE CLEMMONS RD, LEWISVILLE, NC 27023-8251
(336) 712-0700
(336) 712-0876
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 712-0700
(336) 712-0876
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2005-00855
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5901233
—
NC
05
—
896579A
—
NC
Enumeration date
02/21/2006
Last updated
10/28/2020
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