Basic Information
| Provider Information | |||||||||
| NPI: | 1164537478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | KIMBERLEY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | C.N.M. ; M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 63314 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282633314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286961132 | ||||||||
| FaxNumber: | 8286961134 | ||||||||
| Practice Location | |||||||||
| Address1: | 512 6TH AVE W | ||||||||
| Address2: | |||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287393558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286960897 | ||||||||
| FaxNumber: | 8286922146 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 08/01/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 374 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 7002152 | 05 | NC | MEDICAID |