Healthcare Provider Details

I. General information

NPI: 1033043567
Provider Name (Legal Business Name): KIMBERLEY BIVINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 KNOLLS DR UNIT 205
NEWPORT NEWS VA
23602-5744
US

IV. Provider business mailing address

509 KNOLLS DR UNIT 205
NEWPORT NEWS VA
23602-5744
US

V. Phone/Fax

Practice location:
  • Phone: 757-698-5020
  • Fax: 757-698-5020
Mailing address:
  • Phone: 757-698-5020
  • Fax: 757-698-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: