MEDICARE: KIMBERLY SCOTT, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C004666	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790166593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBERLY SCOTT, PLLC

Provider Business Mailing Address
First Line	:	112 BROOKS ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2757
Country	:	US
Telephone Number	:	919-324-7361
Fax Number	:	919-640-1901

Provider Business Practice Location Address
First Line	:	112 BROOKS ST
Second Line	:
City	:	WAKE FOREST
State	:	NC
Zip	:	27587-2757
Country	:	US
Telephone Number	:	919-324-7361
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY SCOTT
Credential	:	LCSW
Telephone Number	:	919-414-3452

Provider Enumeration Date	:	06/17/2015
Last Update Date	:	06/17/2015

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