Provider Demographics
NPI:1780183228
Name:SORRELL, KIMBERLEY BEASLEY (NP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:BEASLEY
Last Name:SORRELL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10620 SPOTSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2637
Mailing Address - Country:US
Mailing Address - Phone:540-374-3150
Mailing Address - Fax:
Practice Address - Street 1:10620 SPOTSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2637
Practice Address - Country:US
Practice Address - Phone:540-374-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175859363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily