Healthcare Provider Details

I. General information

NPI: 1134862311
Provider Name (Legal Business Name): PREMIER AESTHETICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 S MAIN ST
DANVILLE VA
24541-4001
US

IV. Provider business mailing address

927 S MAIN ST
DANVILLE VA
24541-4001
US

V. Phone/Fax

Practice location:
  • Phone: 434-425-3545
  • Fax: 833-615-2138
Mailing address:
  • Phone: 434-425-3545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KIM RENEE NESTER
Title or Position: OWNER
Credential:
Phone: 434-425-3545