Healthcare Provider Details

I. General information

NPI: 1104822295
Provider Name (Legal Business Name): KIMBERLY A SCOTT N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 INDEPENDENCE PKWY STE 100
CHESAPEAKE VA
23320-5197
US

IV. Provider business mailing address

1291 CUTTER PT
VIRGINIA BEACH VA
23454-2014
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-9714
  • Fax: 757-547-0725
Mailing address:
  • Phone: 559-836-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1505
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24167669
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: