Provider Demographics
NPI:1851035257
Name:WARD, KIMBERLY CARROLL
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CARROLL
Last Name:WARD
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 1:444 ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-2020
Mailing Address - Country:US
Mailing Address - Phone:336-782-0089
Mailing Address - Fax:
Practice Address - Street 1:1031 E MOUNTAIN ST BLDG 319
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7998
Practice Address - Country:US
Practice Address - Phone:866-768-8479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-22
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148721835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric