Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 2010-01616 | NC |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 2010-01616 | NC |
NPI | 1679641872 |
---|---|
Provider Name | Kim Marie Kinsley |
First Address | Winston Salem, NC 27103-6074 |
Second Address | Jonesville, NC 28642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2006 |
Last Update Date | 18/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
46822 | (02) | CO |