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General NPI Number Information
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NPI Number | 1154856466
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Entity Type | Individual
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Provider Name | KIM PUCKETT FNP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2017
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 120 COUNTY HOME RD
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City | ROCKINGHAM
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State | NC
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Zip | 28379-9118
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Country | US
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Telephone | 910-997-3733
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Fax | 910-997-3707
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Provider Business Mailing Address
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Address Line | PO BOX 828
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City | HAMLET
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State | NC
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Zip | 28345-0828
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Country | US
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Telephone | 910-997-3733
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Fax | 910-997-3707
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5009466
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License Number State | NC
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