Healthcare Provider Details

I. General information

NPI: 1508903113
Provider Name (Legal Business Name): KIMBERLY D DULA MSN, APRN, BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/19/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E WATAUGA AVE
JOHNSON CITY TN
37601-4113
US

IV. Provider business mailing address

PO BOX 852
RICHLANDS VA
24641-0852
US

V. Phone/Fax

Practice location:
  • Phone: 276-967-1769
  • Fax:
Mailing address:
  • Phone: 276-356-5729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024165763
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: