Provider Demographics
NPI:1497799365
Name:NIEVES, KIMBERLY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:
Last Name:NIEVES
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 1:1827 ADAMS MILL RD NW
Mailing Address - Street 2:STE C
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2399
Mailing Address - Country:US
Mailing Address - Phone:202-204-7092
Mailing Address - Fax:
Practice Address - Street 1:1201 SEVEN LOCKS RD STE 111
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20854-2957
Practice Address - Country:US
Practice Address - Phone:301-762-5020
Practice Address - Fax:301-294-7569
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334164363L00000X
MDR216543363LF0000X
DCNP200003452363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02774165Medicaid
A400046452Medicare PIN