Provider Demographics
NPI:1942595970
Name:PURCELL, KIMBERLY ALLYSON (RRT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALLYSON
Last Name:PURCELL
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 HWY 11 NORTH
Mailing Address - Street 2:PO BOX 597
Mailing Address - City:LEWISTON WOODVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3473
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 HWY 11 AND 42N
Practice Address - Street 2:
Practice Address - City:LEWISTON WOODVILLE
Practice Address - State:NC
Practice Address - Zip Code:27909-3473
Practice Address - Country:US
Practice Address - Phone:252-348-2763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA-2503227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered