Provider Demographics
NPI:1356883235
Name:CROSBY, KIMBERLY (FNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 MEDICAL PARK DR
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-1100
Mailing Address - Country:US
Mailing Address - Phone:276-378-1341
Mailing Address - Fax:276-378-1205
Practice Address - Street 1:240 MEDICAL PARK BLVD STE 3600
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7349
Practice Address - Country:US
Practice Address - Phone:423-990-2405
Practice Address - Fax:423-990-2414
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174145363LF0000X
TN23423363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356883235Medicaid
VAVVN130AMedicare PIN