Provider Demographics
NPI:1851162242
Name:FERNANDEZ, KIMBERLEE ALISSA (NP)
Entity type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:ALISSA
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2790 GODWIN BLVD STE 360
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8153
Mailing Address - Country:US
Mailing Address - Phone:757-934-4821
Mailing Address - Fax:757-934-4276
Practice Address - Street 1:2790 GODWIN BLVD STE 360
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8153
Practice Address - Country:US
Practice Address - Phone:757-934-4821
Practice Address - Fax:757-934-4276
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN294676363LA2100X, 363LG0600X
VA0024189017363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology