Healthcare Provider Details

I. General information

NPI: 1376946657
Provider Name (Legal Business Name): KIMBERLEY HOHENADEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 11/27/2023
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

3620 JOSEPH SIEWICK DR SUITE 200
FAIRFAX VA
22033-1756
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-3600
  • Fax: 703-391-3414
Mailing address:
  • Phone: 703-620-3211
  • Fax: 703-620-3215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172093
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: