Provider Demographics
NPI:1366860488
Name:LIPSCOMB, KIMBERLY RENE'
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:RENE'
Last Name:LIPSCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 GIDNEY ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5806
Mailing Address - Country:US
Mailing Address - Phone:704-600-8609
Mailing Address - Fax:
Practice Address - Street 1:104 GIDNEY ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5806
Practice Address - Country:US
Practice Address - Phone:704-600-8609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-04
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC923616904175F00000X
NC2033261744P3200X
NC1004704171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No175F00000XOther Service ProvidersNaturopath
No1744P3200XOther Service ProvidersSpecialistProsthetics Case Management