Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 074932-23 | NH |
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP 0990840 | CO |
NPI | 1003240359 |
---|---|
Provider Name | Kimberly S. Macdermott |
First Address | North Conway, NH 03860-7101 |
Second Address | North Conway, NH 03860-7101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2013 |
Last Update Date | 13/02/2018 |