Healthcare Provider Details

I. General information

NPI: 1174570808
Provider Name (Legal Business Name): KIMBALL JANE-MARIE SARGENT MSN, PMHCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JANE MARIE SARGENT-TROLLINGER MSN, RN, CS

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 01/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7155 SUNSET LAKE RD
FUQUAY VARINA NC
27526-8638
US

IV. Provider business mailing address

7155 SUNSET LAKE RD
FUQUAY VARINA NC
27526-8638
US

V. Phone/Fax

Practice location:
  • Phone: 919-838-0804
  • Fax: 919-838-1219
Mailing address:
  • Phone: 919-838-0804
  • Fax: 919-838-1219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number080028
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0261495-01
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number080028
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: