Provider Demographics
NPI:1184155541
Name:TIMBERLAKE, KATHRYN STEWART (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:STEWART
Last Name:TIMBERLAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:LEE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3800 ROBERT PORCHER WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-2559
Mailing Address - Country:US
Mailing Address - Phone:336-282-0376
Mailing Address - Fax:
Practice Address - Street 1:3800 ROBERT PORCHER WAY STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2559
Practice Address - Country:US
Practice Address - Phone:336-282-0376
Practice Address - Fax:336-282-0379
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC202002305207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program