Healthcare Provider Details

I. General information

NPI: 1407343999
Provider Name (Legal Business Name): KIMBERLY ANN EKREM RICE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY EKREM RICE NP

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 CRYSTAL SPRING AVE SW STE 201
ROANOKE VA
24014-2465
US

IV. Provider business mailing address

3533 SOUTHERN BLVD STE 5650
KETTERING OH
45429-1263
US

V. Phone/Fax

Practice location:
  • Phone: 540-853-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number201603496RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.022709
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024193483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: