Provider Demographics
NPI:1194709311
Name:LEFTWICH, KIMBERLY ANNE (RN, MSN-FNP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:ANNE
Last Name:LEFTWICH
Suffix:
Gender:F
Credentials:RN, MSN-FNP
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:ANNE
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23923-0470
Mailing Address - Country:US
Mailing Address - Phone:434-542-5560
Mailing Address - Fax:
Practice Address - Street 1:165 LEGRANDE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23923-3747
Practice Address - Country:US
Practice Address - Phone:434-542-5560
Practice Address - Fax:434-542-5745
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001160613163W00000X
VA0024166238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010094909Medicaid
VA10094887Medicaid
VA010094925Medicaid
VA10094887Medicaid
VA010094909Medicaid
006285C63Medicare PIN
VA010094925Medicaid
006889C87Medicare PIN