Provider Demographics
NPI:1023086972
Name:MORTON, KIMBERLY MICHELLE (NP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:MORTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MICHELLE
Other - Last Name:BOAZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1309 LEES CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2601
Mailing Address - Country:US
Mailing Address - Phone:336-286-5505
Mailing Address - Fax:336-286-5583
Practice Address - Street 1:1309 LEES CHAPEL RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2601
Practice Address - Country:US
Practice Address - Phone:336-286-5505
Practice Address - Fax:336-286-5583
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC121777363L00000X
NC960056363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC118075OtherMEDICAL BOARD
NC121777OtherBOARD OF NURSING
NC118075OtherMEDICAL BOARD
S79603Medicare UPIN