Healthcare Provider Details

I. General information

NPI: 1366860488
Provider Name (Legal Business Name): KIMBERLY RENE' LIPSCOMB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 GIDNEY ST
SHELBY NC
28150-5806
US

IV. Provider business mailing address

104 GIDNEY ST
SHELBY NC
28150-5806
US

V. Phone/Fax

Practice location:
  • Phone: 704-600-8609
  • Fax:
Mailing address:
  • Phone: 704-600-8609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number203326
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number923616904
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number1004704
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: