Provider Demographics
NPI:1467074344
Name:WILLETT, KIMBERLY (RN, APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WILLETT
Suffix:
Gender:F
Credentials:RN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8665 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3405
Mailing Address - Country:US
Mailing Address - Phone:301-585-1250
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:8630 FENTON ST STE 1200
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3808
Practice Address - Country:US
Practice Address - Phone:301-585-1250
Practice Address - Fax:301-585-6289
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR242949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily