Provider Demographics
NPI:1588121230
Name:KEZIMANA, CLEMENT (NP)
Entity type:Individual
Prefix:
First Name:CLEMENT
Middle Name:
Last Name:KEZIMANA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:CLEMENT
Other - Middle Name:
Other - Last Name:KEZIMANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 3910
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-3910
Mailing Address - Country:US
Mailing Address - Phone:540-785-9900
Mailing Address - Fax:
Practice Address - Street 1:PRIMARY AND URGENT CARE LLC
Practice Address - Street 2:2306 PLANK ROAD
Practice Address - City:FEDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-785-9900
Practice Address - Fax:540-785-9960
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily