Provider Demographics
NPI:1477266732
Name:CUSHING, KIMBERLY DAWN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:CUSHING
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 BELMONT ST STE 202
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-1086
Mailing Address - Country:US
Mailing Address - Phone:508-433-3687
Mailing Address - Fax:408-283-1414
Practice Address - Street 1:416 BELMONT ST STE 202
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604-1086
Practice Address - Country:US
Practice Address - Phone:508-433-3687
Practice Address - Fax:508-283-1414
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2329440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily