Healthcare Provider Details

I. General information

NPI: 1821982935
Provider Name (Legal Business Name): KIMBERLY GAFFNEY QUITUGUA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/07/2025
Certification Date: 06/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9612 CHARLESFIELD DR
FREDERICKSBURG VA
22407-8358
US

IV. Provider business mailing address

9612 CHARLESFIELD DR
FREDERICKSBURG VA
22407-8358
US

V. Phone/Fax

Practice location:
  • Phone: 571-488-7159
  • Fax: 571-488-7159
Mailing address:
  • Phone: 571-488-7159
  • Fax: 571-488-7159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF05250852
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: