Healthcare Provider Details

I. General information

NPI: 1386879062
Provider Name (Legal Business Name): KIMBERLY CLARK M.D./PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2009
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MEDICAL PAVILION DR
RAEFORD NC
28376-9111
US

IV. Provider business mailing address

26 OXTON CIR
PINEHURST NC
28374-8880
US

V. Phone/Fax

Practice location:
  • Phone: 910-904-8000
  • Fax:
Mailing address:
  • Phone: 404-824-1518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2013-00534
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: