Healthcare Provider Details

I. General information

NPI: 1982494472
Provider Name (Legal Business Name): KIMBERLY MIERS ZOGG NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 KEYWORTH CT
RALEIGH NC
27612-6469
US

IV. Provider business mailing address

1604 KEYWORTH CT
RALEIGH NC
27612-6469
US

V. Phone/Fax

Practice location:
  • Phone: 908-616-2117
  • Fax:
Mailing address:
  • Phone: 908-616-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-4078469
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: