Individual
KIMBERLY WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
8 ROCKY RIDGE PT, GREENSBORO, NC 27405-5545
(336) 895-7540
Mailing address
8 ROCKY RIDGE PT, GREENSBORO, NC 27405-5545
(336) 895-7540
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
—
NC
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
257100
—
NC
Enumeration date
01/16/2020
Last updated
01/16/2020
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