| Doctor Name: | MRS. KIMBERLY RANDALL BOOKER |
| NPI Number: | 1013359934 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CNM, WHNP-BC |
| License Number: | BOO104379455 |
| Business Practice Address: | 520 Maple Ave Suite C Reidsville, NC - 273204652 |
| Business Phone Number: | 3363426063 |
| Business Fax Number: | 3363426066 |
| Mailing Address: | 3871 Vance Street Ext, REIDSVILLE |
| State: | NC |
| Postal Code: | 273208873 |
| Phone Number: | 3366130904 |
| Fax Number: | |
| NPI Enumeration Date: | 07/19/2013 |
| NPI Last Update Date: | 04/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LW0102X |
| License Number: | BOO104379455 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Women's Health |
| Taxonomy Definition: | |