Provider Demographics
NPI:1245916733
Name:FREISENBRUCH, KIMBERLY DYANA (DNP, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DYANA
Last Name:FREISENBRUCH
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 W VIRGINIA BEACH BLVD STE 140
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2030
Mailing Address - Country:US
Mailing Address - Phone:757-452-3934
Mailing Address - Fax:
Practice Address - Street 1:129 W VIRGINIA BEACH BLVD STE 140
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2030
Practice Address - Country:US
Practice Address - Phone:757-452-3934
Practice Address - Fax:833-471-5922
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187437363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health