| Doctor Name: | KIMBERLY CAROL WYNN |
| NPI Number: | 1336149673 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 101832 |
| Business Practice Address: | 610 E Martin Luther King Jr Dr Maxton, NC - 283641800 |
| Business Phone Number: | 9108445253 |
| Business Fax Number: | 9108443290 |
| Mailing Address: | 60 Commerce Plz, PEMBROKE |
| State: | NC |
| Postal Code: | 283727386 |
| Phone Number: | 9105212900 |
| Fax Number: | 9107759165 |
| NPI Enumeration Date: | 07/28/2005 |
| NPI Last Update Date: | 06/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 101832 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |