MEDICARE: KIMESHA KELLY SPINKS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	103K00000X	Behavior Analyst
3	104100000X	Social Worker
4	171M00000X	Case Manager/Care Coordinator
5	172V00000X	Community Health Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	21940	OTHER	NC	LCAS-A

General Provider Information

NPI Number	:	1578916789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMESHA KELLY SPINKS MA

Provider Business Mailing Address
First Line	:	525 GREENBRIAR FARM TRL
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-9284
Country	:	US
Telephone Number	:	336-302-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 GREENBRIAR FARM TRL
Second Line	:
City	:	SILER CITY
State	:	NC
Zip	:	27344-9284
Country	:	US
Telephone Number	:	336-302-0801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2016
Last Update Date	:	07/22/2016

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