Kimberley Bennett, NUTRITIONIST

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A22363 Issued in NC

Practice address

1260 College Ave Ste 1
Wilkesboro, NC 28697-2700

Phone

(336) 818-0733

NPI assigned

Mar 14, 2021

Last updated

Dec 18, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Kimberley Jordan Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1615680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1766016000000",
    "number": "1790360485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1260 COLLEGE AVE STE 1",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286972700",
            "telephone_number": "336-818-0733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1260 COLLEGE AVE STE 1",
            "city": "WILKESBORO",
            "state": "NC",
            "postal_code": "286972700",
            "telephone_number": "336-818-0733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "KIMBERLEY",
        "name_prefix": "Mrs.",
        "credential": "NUTRITIONIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-14",
        "last_updated": "2025-12-18",
        "certification_date": "2025-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A22363",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "jodiprovincecs.com",
            "affiliation": "Y",
            "endpointDescription": "website",
            "affiliationName": "Jodi Province Counseling Services PLLC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "messaging",
            "address_1": "1260 College Ave Ste 1",
            "city": "Wilkesboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "286972700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIMBERLEY",
            "last_name": "JORDAN",
            "prefix": "MISS",
            "credential": "NUTRITIONIST",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Wilkesboro, NC
• Providers in Wilkesboro, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.