Provider Demographics
NPI:1982899936
Name:MCCUEN, KIMBERLY A (RN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:MCCUEN
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:7015C MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310
Mailing Address - Country:US
Mailing Address - Phone:703-971-6900
Mailing Address - Fax:703-372-5244
Practice Address - Street 1:10527 BRADDOCK RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-2247
Practice Address - Country:US
Practice Address - Phone:703-425-3300
Practice Address - Fax:703-372-5244
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017136898363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics