Provider Demographics
NPI:1154601664
Name:AYCOCK, KIMBERLY MICHELE (RRT, RCP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:MICHELE
Last Name:AYCOCK
Suffix:
Gender:F
Credentials:RRT, RCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 TECHNOLOGY DR
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7949
Mailing Address - Country:US
Mailing Address - Phone:919-780-5900
Mailing Address - Fax:919-780-5905
Practice Address - Street 1:343 TECHNOLOGY DR
Practice Address - Street 2:SUITE 1110
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-7949
Practice Address - Country:US
Practice Address - Phone:919-780-5900
Practice Address - Fax:919-780-5905
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5047227900000X
2279P1004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
No2279P1004XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary Diagnostics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA-5047OtherNORTH CAROLINA RESPIRATORY CARE BOARD