Healthcare Provider Details

I. General information

NPI: 1316517501
Provider Name (Legal Business Name): KIMBERLY JOHNSON HAYES CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/02/2021
Certification Date: 07/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 MERRIMAC TRL
WILLIAMSBURG VA
23185-5349
US

IV. Provider business mailing address

701 MERRIMAC TRL
WILLIAMSBURG VA
23185-5349
US

V. Phone/Fax

Practice location:
  • Phone: 757-229-0131
  • Fax: 757-229-6195
Mailing address:
  • Phone: 757-229-0131
  • Fax: 757-229-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number0230003939
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: