Healthcare Provider Details

I. General information

NPI: 1558356808
Provider Name (Legal Business Name): KIMBERLY MCCUE FNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1640
  • Fax:
Mailing address:
  • Phone: 703-784-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170174
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: