Healthcare Provider Details

I. General information

NPI: 1457069916
Provider Name (Legal Business Name): KIMBERLEY COOK YOUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 MORGANTON BLVD SW
LENOIR NC
28645-8183
US

IV. Provider business mailing address

5221 PARAMOUNT PKWY STE 220
MORRISVILLE NC
27560-5490
US

V. Phone/Fax

Practice location:
  • Phone: 828-757-8950
  • Fax: 828-757-8968
Mailing address:
  • Phone: 984-215-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15077
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: