Basic Information
| Provider Information | |||||||||
| NPI: | 1871215905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENRIQUEZ | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANNE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4349 SPRING ST | ||||||||
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| City: | MATTHEWS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281057151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7042994552 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1025 MOREHEAD MEDICAL DR STE 400 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044461700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2022 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.