Healthcare Provider Details

I. General information

NPI: 1093809782
Provider Name (Legal Business Name): KIMBERLY D FOX M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 E BOOKER DAIRY RD
SMITHFIELD NC
27577-9472
US

IV. Provider business mailing address

1519 E BOOKER DAIRY RD
SMITHFIELD NC
27577-9472
US

V. Phone/Fax

Practice location:
  • Phone: 919-938-2144
  • Fax: 919-938-2944
Mailing address:
  • Phone: 919-938-2144
  • Fax: 919-938-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200101445
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier891313G
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: