1336280742 NPI number — KIMBERLY H PARRETT P.A.

Table of content: KIMBERLY H PARRETT P.A. (NPI 1336280742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336280742 NPI number — KIMBERLY H PARRETT P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARRETT
Provider First Name:
KIMBERLY
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336280742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
148 VALLEYBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKIN
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28621-3137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-408-0810
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
631 CC CAMP RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKIN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28621-8705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-366-1072
Provider Business Practice Location Address Fax Number:
336-527-7083
Provider Enumeration Date:
02/09/2007

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: 363AM0700X , with the licence number:  101357 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 101357 , 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)

  • Identifier: B667 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 454639427 . This is a "TAX ID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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