Provider Demographics
NPI:1922162841
Name:PEAY, KIMBERLY ANN (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANN
Last Name:PEAY
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 IDAHO AVE NW
Mailing Address - Street 2:#304
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-5733
Mailing Address - Country:US
Mailing Address - Phone:202-782-4088
Mailing Address - Fax:202-782-2310
Practice Address - Street 1:6900 GEORGIA AVE NW
Practice Address - Street 2:BLDG 2 - WARD 56
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0003
Practice Address - Country:US
Practice Address - Phone:202-782-4088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN962050171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024164512OtherNURSE PRACTITIONER
DCRN962050OtherNURSE PRACTITIONER