Provider Demographics
NPI:1285734079
Name:REXRODE, KIMBERLY LYNNE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:REXRODE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PARK DR
Mailing Address - Street 2:PO DRAWER Z
Mailing Address - City:HOT SPRINGS
Mailing Address - State:VA
Mailing Address - Zip Code:24445-2921
Mailing Address - Country:US
Mailing Address - Phone:540-839-7197
Mailing Address - Fax:
Practice Address - Street 1:106 PARK DR
Practice Address - Street 2:PO DRAWER Z
Practice Address - City:HOT SPRINGS
Practice Address - State:VA
Practice Address - Zip Code:24445-2921
Practice Address - Country:US
Practice Address - Phone:540-839-7197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167057363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285734079Medicaid
VA1285734079Medicaid
012959B70Medicare PIN