Healthcare Provider Details

I. General information

NPI: 1841289386
Provider Name (Legal Business Name): KIMBERLY D GOAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ELM ST
CHRISTIANSBURG VA
24073-1515
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-731-7631
  • Fax: 540-639-3950
Mailing address:
  • Phone: 540-224-5715
  • Fax: 540-224-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024166718
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: