MEDICARE: KIMBERLY YVETTE GRIFFIN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	0734002385	VA
2	174H00000X	Health Educator		VA
3	3747P1801X	Personal Care Attendant
4	246RP1900X	Phlebotomy Technician	2839578	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114570991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY YVETTE GRIFFIN

Provider Business Mailing Address
First Line	:	5228 PIRATA PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1979
Country	:	US
Telephone Number	:	757-705-6687
Fax Number	:

Provider Business Practice Location Address
First Line	:	5228 PIRATA PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-1979
Country	:	US
Telephone Number	:	757-705-6687
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	11/15/2019

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