Provider Demographics
NPI:1558453720
Name:HALL, KIMBERLY D (CFNP)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:D
Last Name:HALL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BLACKWELL RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2600
Mailing Address - Country:US
Mailing Address - Phone:540-347-1621
Mailing Address - Fax:540-347-1621
Practice Address - Street 1:510 BLACKWELL RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2600
Practice Address - Country:US
Practice Address - Phone:540-347-1621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165542363L00000X, 363LF0000X
FLARNP9382948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA143273ZCCUMedicare UPIN
VAMC11112Medicare UPIN