Provider Demographics
NPI:1669620092
Name:CARPENTER, KYMBERLY REID (BSN, RN, BC)
Entity type:Individual
Prefix:MRS
First Name:KYMBERLY
Middle Name:REID
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:BSN, RN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 MOUNTAIN LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-2663
Mailing Address - Country:US
Mailing Address - Phone:540-303-2548
Mailing Address - Fax:540-536-6002
Practice Address - Street 1:214 S BRADDOCK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4043
Practice Address - Country:US
Practice Address - Phone:540-303-2548
Practice Address - Fax:540-536-6002
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001068639261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service