Healthcare Provider Details

I. General information

NPI: 1588121230
Provider Name (Legal Business Name): CLEMENT KEZIMANA NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CLEMENT KEZIMANA NP

II. Dates (important events)

Enumeration Date: 02/28/2019
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRIMARY AND URGENT CARE LLC 2306 PLANK ROAD
FEDERICKSBURG VA
22401
US

IV. Provider business mailing address

PO BOX 3910
FREDERICKSBURG VA
22402-3910
US

V. Phone/Fax

Practice location:
  • Phone: 540-785-9900
  • Fax: 540-785-9960
Mailing address:
  • Phone: 540-785-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024177049
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: