Provider Demographics
NPI:1003043530
Name:CASEY, KIMBERLY ROBERTS
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ROBERTS
Last Name:CASEY
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 1:7056 FRIENDSHIP CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-9721
Mailing Address - Country:US
Mailing Address - Phone:336-621-3663
Mailing Address - Fax:
Practice Address - Street 1:7056 FRIENDSHIP CHURCH RD
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9721
Practice Address - Country:US
Practice Address - Phone:336-621-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)