| Mrs Kimberly Randall Booker, CNM, WHNP-BC | |
|
520 Maple Ave, Suite C, Reidsville, NC 27320-4652 | |
| (336) 342-6063 | |
| (336) 342-6066 |
| Full Name | Mrs Kimberly Randall Booker |
|---|---|
| Gender | Female |
| Speciality | Certified Nurse Midwife (cnm) |
| Experience | 13 Years |
| Location | 520 Maple Ave, Reidsville, North Carolina |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013359934 | NPI | - | NPPES |
| 1799G | Other | BCBS | |
| Q44206A | Other | MEDICARE INDIVIDUAL PTAN LINKED TO FACULTY PRACTICE GROUP | |
| 1013359934 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LW0102X | Nurse Practitioner - Women's Health | BOO104379455 (North Carolina) | Secondary |
| 367A00000X | Advanced Practice Midwife | 522 (North Carolina) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Moses H. Cone Memorial Hospital, The | Greensboro, NC | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| The Moses H Cone Memorial Hospital Operating Corporation | 6204744600 | 724 |
| Entity Name | The Moses H Cone Memorial Hospital Operating Corporation |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356372064 PECOS PAC ID: 6204744600 Enrollment ID: O20031124000541 |
| Entity Name | Moses Cone Physician Services, Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1093953127 PECOS PAC ID: 4284782210 Enrollment ID: O20090501000202 |
| Mailing Address | Practice Location Address |
|---|---|
| Mrs Kimberly Randall Booker, CNM, WHNP-BC 3871 Vance Street Ext, Reidsville, NC 27320-8873 Ph: (336) 613-0904 | Mrs Kimberly Randall Booker, CNM, WHNP-BC 520 Maple Ave, Suite C, Reidsville, NC 27320-4652 Ph: (336) 342-6063 |
Frances Hough Cresenzo-dishmon, CNM Advanced Practice Midwife Medicare: Medicare Enrolled Practice Location: 520 Maple Ave, Suite C, Reidsville, NC 27320 Phone: 336-342-6063 Fax: 336-342-6066 |