Provider Demographics
NPI:1457720039
Name:RICHARDS, KIMBERLEY A (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:RICHARDS
Suffix:
Gender:F
Credentials:MSN, RN, FNP-BC
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:ANNE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1424 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-9439
Mailing Address - Country:US
Mailing Address - Phone:434-981-9529
Mailing Address - Fax:
Practice Address - Street 1:1046 TULIP TER
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-5324
Practice Address - Country:US
Practice Address - Phone:434-981-9529
Practice Address - Fax:540-438-0023
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMR6631685OtherDEA