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General NPI Number Information
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NPI Number | 1013359934
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Entity Type | Individual
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Provider Name | KIMBERLY RANDALL BOOKER CNM, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/19/2013
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 520 MAPLE AVE SUITE C
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City | REIDSVILLE
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State | NC
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Zip | 27320-4652
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Country | US
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Telephone | 336-342-6063
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Fax | 336-342-6066
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Provider Business Mailing Address
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Address Line | 3871 VANCE STREET EXT
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City | REIDSVILLE
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State | NC
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Zip | 27320-8873
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Country | US
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Telephone | 336-613-0904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | BOO104379455
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 522
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License Number State | NC
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