Healthcare Provider Details

I. General information

NPI: 1245601525
Provider Name (Legal Business Name): KIMBERLY QUARLES RN, MSN-ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MISTYWOOD RD
NORTH CHESTERFIELD VA
23236-2865
US

IV. Provider business mailing address

101 MISTYWOOD RD
NORTH CHESTERFIELD VA
23236-2865
US

V. Phone/Fax

Practice location:
  • Phone: 434-987-1228
  • Fax:
Mailing address:
  • Phone: 434-987-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number0001193208
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001193208
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number0001193208
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: