Provider Demographics
NPI:1922879592
Name:ROGERS, KIMBERLY DOWLESS (RN, CDCES)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DOWLESS
Last Name:ROGERS
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SCHLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE WACCAMAW
Mailing Address - State:NC
Mailing Address - Zip Code:28450-2342
Mailing Address - Country:US
Mailing Address - Phone:910-840-3567
Mailing Address - Fax:910-777-5031
Practice Address - Street 1:510 CAROLINA BAY DR STE 200
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2046
Practice Address - Country:US
Practice Address - Phone:910-662-8927
Practice Address - Fax:910-777-5031
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121628163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator