Provider Demographics
NPI:1922069723
Name:EDWARDS, KIMBERLY REYNOLDS (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:REYNOLDS
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6781 PARKER FARM DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-3161
Mailing Address - Country:US
Mailing Address - Phone:910-763-1555
Mailing Address - Fax:910-762-4726
Practice Address - Street 1:6781 PARKER FARM DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3161
Practice Address - Country:US
Practice Address - Phone:910-763-1555
Practice Address - Fax:910-762-4726
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200300028207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13363OtherBCBS STATE
NC13363OtherBCBS FEDERAL
NC13363OtherBCBS NC
NCP00103572OtherRRMEDICARE
NCH85890Medicare UPIN
NC13363OtherBCBS STATE