Healthcare Provider Details

I. General information

NPI: 1942833165
Provider Name (Legal Business Name): KIMBERLY BYSHEIM CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28105 THREE NOTCH RD # 1C
MECHANICSVILLE MD
20659-3235
US

IV. Provider business mailing address

1401 HOLLY WOODS DR
LUSBY MD
20657-4144
US

V. Phone/Fax

Practice location:
  • Phone: 301-290-1510
  • Fax: 301-290-1574
Mailing address:
  • Phone: 410-474-5251
  • Fax: 301-290-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR206634
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: