Healthcare Provider Details

I. General information

NPI: 1871359893
Provider Name (Legal Business Name): KIMBERLY NICHOLSON MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 03/01/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 MOOREFIELD CT
DURHAM NC
27705-2058
US

IV. Provider business mailing address

14 MOOREFIELD CT
DURHAM NC
27705-2058
US

V. Phone/Fax

Practice location:
  • Phone: 919-532-9520
  • Fax: 919-597-7197
Mailing address:
  • Phone: 919-532-9520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number266651
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code246W00000X
TaxonomyCardiology Technician
License Number266651
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: