Provider Demographics
NPI:1518030758
Name:VIVALDI, KIMBERLY BUTLER (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BUTLER
Last Name:VIVALDI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10326 ROSE GARDEN PATH
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:26113
Mailing Address - Country:US
Mailing Address - Phone:804-550-9546
Mailing Address - Fax:
Practice Address - Street 1:2401 HARTMAN STREET
Practice Address - Street 2:BUILDING A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2458
Practice Address - Country:US
Practice Address - Phone:804-343-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001119875163W00000X, 163WS0200X
VA0024119875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WS0200XNursing Service ProvidersRegistered NurseSchool
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily