Provider Demographics
NPI:1184656324
Name:WASHBOURNE, KIMBERLEY D (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:D
Last Name:WASHBOURNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 MARTIN LUTHER KING JR AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-5700
Mailing Address - Country:US
Mailing Address - Phone:202-715-4444
Mailing Address - Fax:
Practice Address - Street 1:2228 MARTIN LUTHER KING JR AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-5700
Practice Address - Country:US
Practice Address - Phone:202-715-4444
Practice Address - Fax:202-715-4444
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANP500226390363L00000X
VA0024166086363LF0000X
DCNP500226390363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV9379E533Medicare PIN