Healthcare Provider Details

I. General information

NPI: 1467549352
Provider Name (Legal Business Name): KIMBERLY JONES RITENOUR PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2924 BROOK RD CHILDREN'S HOSPITAL
RICHMOND VA
23220-1215
US

IV. Provider business mailing address

2924 BROOK RD CHILDREN'S HOSPITAL CREDENTIALING DEPT
RICHMOND VA
23220-1215
US

V. Phone/Fax

Practice location:
  • Phone: 804-321-7474
  • Fax: 804-228-5210
Mailing address:
  • Phone: 804-321-7474
  • Fax: 804-228-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number0024086007
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: