Provider Demographics
NPI:1356484232
Name:CASE, KIMBERLY ANNE (MD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ANNE
Last Name:CASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 QUEENS RD STE 510
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-3215
Mailing Address - Country:US
Mailing Address - Phone:980-302-6440
Mailing Address - Fax:980-302-6445
Practice Address - Street 1:125 QUEENS RD STE 510
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3215
Practice Address - Country:US
Practice Address - Phone:980-302-6440
Practice Address - Fax:980-302-6445
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00877207Q00000X, 207RH0002X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC810639OtherPARTNERS
NC9746068OtherAETNA
NC146F7OtherBLUE CROSS
NC202028OtherMEDCOST
WV3810009712Medicaid
NC5907442Medicaid
SCQ77008Medicaid
2070430Medicare PIN