Healthcare Provider Details

I. General information

NPI: 1013261098
Provider Name (Legal Business Name): KIMBERLY OKAFOR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2012
Last Update Date: 10/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SUNNYBROOK RD
RALEIGH NC
27610-1827
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR SUITE 100
CONCORD NC
28025-1894
US

V. Phone/Fax

Practice location:
  • Phone: 919-278-2687
  • Fax:
Mailing address:
  • Phone: 704-939-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number37802172
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: