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General NPI Number Information
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NPI Number | 1851866768
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Entity Type | Individual
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Provider Name | JILLIAN KIME MAED
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Gender | Female
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Dates
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Enumeration Date | 10/06/2018
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Last Update Date | 10/06/2018
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Provider Practice Location Address
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Address Line | 241 COMMERCE ST STE A
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City | GREENVILLE
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State | NC
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Zip | 27858-5029
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Country | US
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Telephone | 252-714-1863
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Fax | 252-364-3226
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Provider Business Mailing Address
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Address Line | 1104 SCARLET OAK DR
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City | GREENVILLE
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State | NC
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Zip | 27858-8444
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Country | US
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Telephone | 910-590-7788
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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 | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 2018374059
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License Number State | NC
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