Organization
MOONLIGHT PEDIATRIC URGENT CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY D. FOX MD (OWNER)
(919) 938-2144
Entity
Organization
Contact information
Practice address
3117 ROGERS RD STE 120, WAKE FOREST, NC 27587-3803
(919) 938-2144
(919) 938-2144
Mailing address
1519 E BOOKER DAIRY RD STE A, SMITHFIELD, NC 27577-9472
(919) 938-2144
(919) 938-2944
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
200101445
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891313G
—
NC
Enumeration date
10/13/2017
Last updated
10/13/2017
Update your record
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