Provider Demographics
NPI:1093875338
Name:ADAMS, KIMBERLY STEWART (PSYD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:STEWART
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:JARRETT
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 MILITARY CUTOFF RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2375
Mailing Address - Country:US
Mailing Address - Phone:910-254-4818
Mailing Address - Fax:910-254-4819
Practice Address - Street 1:710 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 120
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2375
Practice Address - Country:US
Practice Address - Phone:910-254-4818
Practice Address - Fax:910-254-4819
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3437103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6001005Medicaid
P12194Medicare UPIN
NC6001005Medicaid