Healthcare Provider Details

I. General information

NPI: 1922969401
Provider Name (Legal Business Name): KIMBERLY MH TOFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/25/2025
Certification Date: 11/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

13125 CROSS KEYS CT
FAIRFAX VA
22033-1426
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4402
  • Fax: 703-776-4402
Mailing address:
  • Phone: 703-776-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001275880
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: