1275814758 NPI number — MRS. KIMBERLY LEWIS AGAMEDI NP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275814758 NPI number — MRS. KIMBERLY LEWIS AGAMEDI NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGAMEDI
Provider First Name:
KIMBERLY
Provider Middle Name:
LEWIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WRIGHT
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
LEWIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275814758
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1175 REVOLUTION MILL DR STE 10
Provider Second Line Business Mailing Address:
1175 REVOLUTION MILL DRIVE, STE 10
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-459-3335
Provider Business Mailing Address Fax Number:
336-450-1980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1175 REVOLUTION MILL DR STE 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27405-5080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-459-3335
Provider Business Practice Location Address Fax Number:
336-450-1980
Provider Enumeration Date:
08/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  5005328 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 5005328 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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