Healthcare Provider Details

I. General information

NPI: 1508091919
Provider Name (Legal Business Name): KELLY SMITH KIMPLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY MARIE SMITH MD

II. Dates (important events)

Enumeration Date: 05/29/2009
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR.
CHAPEL HILL NC
27599
US

IV. Provider business mailing address

231 MACNIDER HALL CAMPUS BOX 7225
CHAPEL HILL NC
27599
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-2504
  • Fax: 919-966-3852
Mailing address:
  • Phone: 919-966-1072
  • Fax: 919-966-8419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2012-01050
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: