Provider Demographics
NPI:1356718001
Name:VIGNOLA, KIMBERLY W (AGNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:W
Last Name:VIGNOLA
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:W
Other - Last Name:PROCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300, CCHS PHYSICIAN CONTRACTING
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4755 OGLETOWN STANTON RD
Practice Address - Street 2:ROOM E1070 CENTER FOR HEART & VASCULAR HEALTH AT CHRIST
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19718-2200
Practice Address - Country:US
Practice Address - Phone:302-623-1929
Practice Address - Fax:302-733-4533
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELP-0000139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner