Healthcare Provider Details

I. General information

NPI: 1396515532
Provider Name (Legal Business Name): KIMBER LEIGH AYCOCK CFO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 PAGE RD N BLDG 3
PINEHURST NC
28374-4637
US

IV. Provider business mailing address

PO BOX 4754
PINEHURST NC
28374-4754
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-2828
  • Fax: 910-295-2996
Mailing address:
  • Phone: 910-295-2828
  • Fax: 910-295-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

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: