Healthcare Provider Details

I. General information

NPI: 1780909531
Provider Name (Legal Business Name): KIMBERLY MARIE ST. JEAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 MEDICAL AVE
HARRISONBURG VA
22801-3437
US

IV. Provider business mailing address

PO BOX 79777
BALTIMORE MD
21279-0777
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5600
  • Fax: 540-564-5601
Mailing address:
  • Phone: 757-252-2900
  • Fax: 757-252-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0101253971
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: