Provider Demographics
NPI:1588046239
Name:KLIMCZYK, LAURIE (AGNP-C)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:KLIMCZYK
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:693 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24352-3647
Mailing Address - Country:US
Mailing Address - Phone:276-966-0711
Mailing Address - Fax:276-966-0711
Practice Address - Street 1:693 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:LAUREL FORK
Practice Address - State:VA
Practice Address - Zip Code:24352-3647
Practice Address - Country:US
Practice Address - Phone:276-966-0711
Practice Address - Fax:276-966-0711
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009491363L00000X
NYF307231363L00000X
VA0024192471363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner