Healthcare Provider Details

I. General information

NPI: 1598242026
Provider Name (Legal Business Name): KIMBERLY MCGRAW FNP-BC, EMT-P, LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 TOPSHAM FAIR MALL RD STE 8
TOPSHAM ME
04086
US

IV. Provider business mailing address

19 CONFORTE HILL RD
BRIDGTON ME
04009-4149
US

V. Phone/Fax

Practice location:
  • Phone: 207-798-6333
  • Fax:
Mailing address:
  • Phone: 207-647-2897
  • Fax: 207-647-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN47284
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number11021
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT1574
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number078816-23
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP181081
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: