Provider Demographics
NPI:1275814758
Name:AGAMEDI, KIMBERLY LEWIS (NP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LEWIS
Last Name:AGAMEDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LEWIS
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1175 REVOLUTION MILL DR STE 10
Mailing Address - Street 2:1175 REVOLUTION MILL DRIVE, STE 10
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405
Mailing Address - Country:US
Mailing Address - Phone:336-459-3335
Mailing Address - Fax:336-450-1980
Practice Address - Street 1:1175 REVOLUTION MILL DR STE 10
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-5080
Practice Address - Country:US
Practice Address - Phone:336-459-3335
Practice Address - Fax:336-450-1980
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005328363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily