Provider Demographics
NPI:1407412851
Name:SARGENT, KIMBERLY L (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:SARGENT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101C WOODMARK ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-1246
Mailing Address - Country:US
Mailing Address - Phone:540-672-0793
Mailing Address - Fax:540-672-3531
Practice Address - Street 1:101C WOODMARK ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-1246
Practice Address - Country:US
Practice Address - Phone:540-672-0793
Practice Address - Fax:540-672-3531
Is Sole Proprietor?:No
Enumeration Date:2019-05-10
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001185246163W00000X
VA0024177700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse