Provider Demographics
NPI:1073751210
Name:JONES, KIMBERLY SHOEMAKER
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SHOEMAKER
Last Name:JONES
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:PO BOX 362
Mailing Address - Street 2:306 EAST ARROWHEAD DRIVE
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28329-0362
Mailing Address - Country:US
Mailing Address - Phone:910-990-6050
Mailing Address - Fax:
Practice Address - Street 1:306 E ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3000
Practice Address - Country:US
Practice Address - Phone:910-990-6050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC58712251P0200X
NC117822251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics