Healthcare Provider Details

I. General information

NPI: 1942612890
Provider Name (Legal Business Name): KIMBERLEY SMITH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2014
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 COUNTRY DAY RD
GOLDSBORO NC
27530-8888
US

IV. Provider business mailing address

623 COUNTRY DAY RD
GOLDSBORO NC
27530-8888
US

V. Phone/Fax

Practice location:
  • Phone: 919-330-1940
  • Fax:
Mailing address:
  • Phone: 919-330-1940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5007058
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: