Provider Demographics
NPI:1508903113
Name:DULA, KIMBERLY D (MS, APRN, BC, FNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:DULA
Suffix:
Gender:F
Credentials:MS, APRN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 E TOWER ST
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-1343
Mailing Address - Country:US
Mailing Address - Phone:276-356-5729
Mailing Address - Fax:
Practice Address - Street 1:18765 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656
Practice Address - Country:US
Practice Address - Phone:276-395-2880
Practice Address - Fax:276-395-2889
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ00429Medicare UPIN