Healthcare Provider Details

I. General information

NPI: 1669008348
Provider Name (Legal Business Name): KIMBERLY DAWN GREER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2020
Last Update Date: 08/15/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27018 LEE HWY
ABINGDON VA
24211-7512
US

IV. Provider business mailing address

516 LOWER BEAR WALLOW RD
DANTE VA
24237-7130
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6043
  • Fax:
Mailing address:
  • Phone: 276-495-7797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202002771
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: