Provider Demographics
NPI:1205210788
Name:ROUNDTREE, KIMMALA SHETEF (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMMALA
Middle Name:SHETEF
Last Name:ROUNDTREE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 KING ST STE 3
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2700
Mailing Address - Country:US
Mailing Address - Phone:571-695-2386
Mailing Address - Fax:571-695-2252
Practice Address - Street 1:1727 KING ST STE 3
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2700
Practice Address - Country:US
Practice Address - Phone:571-695-2386
Practice Address - Fax:571-695-2252
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172748363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily