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General NPI Number Information
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NPI Number | 1275814758
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Entity Type | Individual
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Provider Name | KIMBERLY LEWIS AGAMEDI NP
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Gender | Female
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Dates
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Enumeration Date | 08/29/2011
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 1175 REVOLUTION MILL DR STE 10
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City | GREENSBORO
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State | NC
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Zip | 27405-5080
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Country | US
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Telephone | 336-459-3335
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Fax | 336-450-1980
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Provider Business Mailing Address
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Address Line | 1175 REVOLUTION MILL DR STE 10 1175 REVOLUTION MILL DRIVE, STE 10
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City | GREENSBORO
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State | NC
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Zip | 27405
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Country | US
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Telephone | 336-459-3335
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Fax | 336-450-1980
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5005328
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5005328
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License Number State | NC
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