Provider Demographics
NPI:1679982631
Name:MIREE, KIMBERLY C (LMBT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:C
Last Name:MIREE
Suffix:
Gender:F
Credentials:LMBT
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 17613
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29606-8613
Mailing Address - Country:US
Mailing Address - Phone:910-849-8041
Mailing Address - Fax:
Practice Address - Street 1:201 S MCPHERSON CHURCH RD
Practice Address - Street 2:SUITE 228
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4974
Practice Address - Country:US
Practice Address - Phone:910-849-8041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-04
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12973225700000X
SCMAS.9682225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist