Provider Demographics
NPI:1215793237
Name:BARNWELL, KIMBERLY MYRICK
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MYRICK
Last Name:BARNWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 TROSPER RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1215
Mailing Address - Country:US
Mailing Address - Phone:133-420-1522
Mailing Address - Fax:
Practice Address - Street 1:350 N COX ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5566
Practice Address - Country:US
Practice Address - Phone:336-629-2201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCBARN-FSY1E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine