Provider Demographics
NPI:1669726659
Name:CRAIN, KIMBERLY MICHELLE (APRN,FNP-C,PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MICHELLE
Last Name:CRAIN
Suffix:
Gender:F
Credentials:APRN,FNP-C,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 PAPERBARK TRL
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5611
Mailing Address - Country:US
Mailing Address - Phone:757-615-2561
Mailing Address - Fax:
Practice Address - Street 1:1500 E LITTLE CREEK RD STE 205
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-4137
Practice Address - Country:US
Practice Address - Phone:757-587-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-30
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170600363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1669726659Medicaid
VA1669726659OtherUSA MANAGED CARE
VA1669726659OtherCORVEL
VA1669726659Medicaid
VA1669726659OtherOPTIMA HEALTH
VA1669726659OtherVIRGINIA PREMIER HEALTH PLAN
VA1669726659OtherTRICARE/CHAMPUS
VA1669726659OtherMULTIPLAN
VA1669726659OtherOPTIMA HEALTH