MEDICARE: LYNN KIMSEY APRN

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	363LP2300X	Primary Care Nurse Practitioner	111704	NE
2	363L00000X	Nurse Practitioner	111704	NE
3	363LA2200X	Adult Health Nurse Practitioner	111704	NE
4	363LG0600X	Gerontology Nurse Practitioner	111704	NE

General Provider Information

NPI Number	:	1982012894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN KIMSEY APRN

Provider Business Mailing Address
First Line	:	14121 PARKE LONG CT STE 201
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-1647
Country	:	US
Telephone Number	:	571-512-7287
Fax Number	:

Provider Business Practice Location Address
First Line	:	14121 PARKE LONG CT STE 201
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20151-1647
Country	:	US
Telephone Number	:	571-512-7287
Fax Number	:

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

Provider Enumeration Date	:	07/24/2014
Last Update Date	:	03/25/2026

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