Healthcare Provider Details

I. General information

NPI: 1922879592
Provider Name (Legal Business Name): KIMBERLY DOWLESS ROGERS RN, CDCES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 CAROLINA BAY DR STE 200
WILMINGTON NC
28403-2046
US

IV. Provider business mailing address

103 SCHLEY AVE
LAKE WACCAMAW NC
28450-2342
US

V. Phone/Fax

Practice location:
  • Phone: 910-662-8927
  • Fax: 910-777-5031
Mailing address:
  • Phone: 910-840-3567
  • Fax: 910-777-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number121628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: