Individual provider Active NPI

Kimberlee Lynne Miller-Urban, MA. EDS

  • Clinical Psychologist
  • Wilmington, NC
National Provider Identifier
1104973890
Registry record updated Sep 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2612 Issued in NC
Practice address
2002 Eastwood Rd
Suite 305
Wilmington, NC 28403-7218
Phone
(910) 509-0588
Fax
(910) 509-0586
NPI assigned
Jan 4, 2007
Last updated
Sep 8, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 8, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 2612 NC
Clinical Psychologist 103TC0700X 2612 NC Primary
School Psychologist 103TS0200X 2612 NC

Addresses

Primary practice location

2002 Eastwood Rd
Suite 305
Wilmington, NC 28403-7218

Mailing address

100 N Gadwall CT
Hampstead, NC 28443-7159
Phone (910) 538-5334

Other practice location 1

3317 Masonboro Loop Rd Unit 160
Wilmington, NC 28409-2970
Phone (910) 538-5334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
2612NCMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Psychologial Services, PA Current Accepting new patients
Sound Psychologial Services, PA Current Accepting new patients
Family Works Psychological Center, PLLC Psychologist Past Accepting new patients

Locations

2505 S 17th St
Ste 200
Wilmington, NC 28401
Phone (910) 231-4294

3317 Masonboro Loop Rd
Unit 160
Wilmington, NC 28409
Phone (910) 538-5334

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757289600000",
    "number": "1104973890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N GADWALL CT",
            "city": "HAMPSTEAD",
            "state": "NC",
            "postal_code": "284437159",
            "telephone_number": "910-538-5334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 EASTWOOD RD",
            "address_2": "SUITE 305",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284037218",
            "telephone_number": "910-509-0588",
            "fax_number": "910-509-0586"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3317 Masonboro Loop Rd Unit 160",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284092970",
            "country_code": "US",
            "telephone_number": "910-538-5334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MILLER-URBAN",
        "first_name": "KIMBERLEE",
        "middle_name": "LYNNE",
        "name_prefix": "Ms.",
        "credential": "MA. EDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-04",
        "last_updated": "2025-09-08",
        "certification_date": "2025-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "2612",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "2612",
            "primary": true
        },
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "NC",
            "license": "2612",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.