Provider Demographics
NPI:1558105411
Name:EAST, KIMBERLY CORNETTE (NP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:CORNETTE
Last Name:EAST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 MARSHALL SMITH RD
Mailing Address - Street 2:
Mailing Address - City:KING
Mailing Address - State:NC
Mailing Address - Zip Code:27021-8625
Mailing Address - Country:US
Mailing Address - Phone:336-918-7941
Mailing Address - Fax:
Practice Address - Street 1:101 CABARRUS AVE E STE 200
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-3781
Practice Address - Country:US
Practice Address - Phone:855-743-2247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020256363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily