Provider Demographics
NPI:1770222101
Name:MAY-SEPULVEDA, KIMBERLY SCARLET
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SCARLET
Last Name:MAY-SEPULVEDA
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 1:3758 NC 268 HWY
Mailing Address - Street 2:
Mailing Address - City:PILOT MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:27041-8513
Mailing Address - Country:US
Mailing Address - Phone:336-870-0175
Mailing Address - Fax:
Practice Address - Street 1:3758 NC 268 HWY
Practice Address - Street 2:
Practice Address - City:PILOT MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:27041-8513
Practice Address - Country:US
Practice Address - Phone:336-870-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program