Individual
KIM MARION CAROLLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-6248
Mailing address
179 N HARBOR WATCH DR, STATESVILLE, NC 28677-2483
(516) 316-5392
(516) 316-5392
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
23520
SC
363LA2100X
Acute Care Nurse Practitioner
Primary
5012470
NC
363LA2100X
Acute Care Nurse Practitioner
RN282977
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP64661
—
SC
Enumeration date
11/16/2018
Last updated
11/14/2024
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