Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 5004661 | NC |
NPI | 1003130121 |
---|---|
Provider Name | Mrs. Kimberly C Houston |
First Address | Siler City, NC 27344-3042 |
Second Address | Siler City, NC 27344-3042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/03/2010 |
Last Update Date | 23/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003130121 | NPI (01) | NC |
203118 | RN LICENSE (01) | NC |
5004661 | NURSE PRACTITIONER LICENSE (01) | NC |
MH2147608 | DEA (01) | NC |