Individual
KYMBER BROADHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4330 SOUTHPORT SUPPLY RD SE STE 201, SOUTHPORT, NC 28461-9273
(910) 612-1002
Mailing address
4330 SOUTHPORT SUPPLY RD SE STE 201, SOUTHPORT, NC 28461-9273
(910) 612-1002
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14054
NC
Other
Enumeration date
05/18/2020
Last updated
05/18/2020
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