Provider Demographics
NPI:1194466623
Name:DUNN, KIMBERLY CREW (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:CREW
Last Name:DUNN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:SHEREE
Other - Last Name:CREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6236 FREEDOM CIR
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-1212
Mailing Address - Country:US
Mailing Address - Phone:706-401-9115
Mailing Address - Fax:
Practice Address - Street 1:6236 FREEDOM CIR
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-1212
Practice Address - Country:US
Practice Address - Phone:706-401-9115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily