MEDICARE: KIM FERESSIA MASON

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	3747P1801X	Personal Care Attendant
2	374U00000X	Home Health Aide		VA

General Provider Information

NPI Number	:	1407798804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM FERESSIA MASON

Provider Business Mailing Address
First Line	:	3104 TYRE NECK RD # 203
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-4512
Country	:	US
Telephone Number	:	757-880-3106
Fax Number	:

Provider Business Practice Location Address
First Line	:	3104 TYRE NECK RD # 203
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-4512
Country	:	US
Telephone Number	:	757-880-3106
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “ KIM FERESSIA MASON ” Practice Location

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