Provider Demographics
NPI:1033554126
Name:BODINE, KIMBERLY ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:BODINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MANNING DR
Mailing Address - Street 2:CB #7160
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7160
Mailing Address - Country:US
Mailing Address - Phone:919-966-1078
Mailing Address - Fax:919-966-9646
Practice Address - Street 1:101 MANNING DR
Practice Address - Street 2:CB #7160
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7160
Practice Address - Country:US
Practice Address - Phone:919-966-1078
Practice Address - Fax:919-966-9646
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC256352163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC256352OtherR.N. LICENSE NUMBER