Provider Demographics
NPI:1154856466
Name:PUCKETT, KIM (FNP)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 828
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-0828
Mailing Address - Country:US
Mailing Address - Phone:910-997-3733
Mailing Address - Fax:910-997-3707
Practice Address - Street 1:120 COUNTY HOME RD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-9118
Practice Address - Country:US
Practice Address - Phone:910-997-3733
Practice Address - Fax:910-997-3707
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009466363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner