Basic Information
| Provider Information | |||||||||
| NPI: | 1326667742 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEWESE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 338 WALNUT LN | ||||||||
| Address2: | |||||||||
| City: | VILAS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286929285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7049004562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 175 MARY ST | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282649664 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2020 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5013053 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.