Provider Demographics
NPI:1780614750
Name:BAUMANN, KIMBERLY A (PNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:BAUMANN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4095 BATTLEGROUND AVE.
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-1845
Mailing Address - Country:US
Mailing Address - Phone:336-763-9292
Mailing Address - Fax:
Practice Address - Street 1:4095 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-8410
Practice Address - Country:US
Practice Address - Phone:336-763-9292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
P27321Medicare UPIN