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General NPI Number Information
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NPI Number | 1699123919
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Entity Type | Individual
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Provider Name | KIRK KENDALL KIMMONS LMBT
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Gender | Male
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Dates
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Enumeration Date | 05/26/2016
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Last Update Date | 05/26/2016
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Provider Practice Location Address
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Address Line | 1505 S GLENBURNIE RD SUITE K
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City | NEW BERN
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State | NC
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Zip | 28562-2625
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Country | US
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Telephone | 252-646-7181
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Fax |
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Provider Business Mailing Address
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Address Line | 101 E LARIAT LN
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City | HAVELOCK
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State | NC
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Zip | 28532-2940
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Country | US
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Telephone | 252-646-7181
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | NC 13551
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License Number State | NC
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