Healthcare Provider Details

I. General information

NPI: 1477913879
Provider Name (Legal Business Name): KIMBERLY ROGERS BENNETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2016
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

IV. Provider business mailing address

125 NATIONWIDE DR
LYNCHBURG VA
24502-4272
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-6933
  • Fax: 434-200-6934
Mailing address:
  • Phone: 434-200-6933
  • Fax: 434-200-6934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173333
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: