Provider Demographics
NPI:1275342347
Name:MUNGIN, KIMBLY S
Entity type:Individual
Prefix:
First Name:KIMBLY
Middle Name:S
Last Name:MUNGIN
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 1:11100 NORTHLAKE LANDING DR APT 3106
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-0229
Mailing Address - Country:US
Mailing Address - Phone:912-257-2389
Mailing Address - Fax:
Practice Address - Street 1:11100 NORTHLAKE LANDING DR APT 3106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-0229
Practice Address - Country:US
Practice Address - Phone:912-257-2389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula