MEDICARE: KIMBERLEY WYRICK D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0102202004	VA

General Provider Information

NPI Number	:	1083805683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY WYRICK D.O.

Provider Business Mailing Address
First Line	:	886 SUGAR MAPLE LN
Second Line	:
City	:	ROCKINGHAM
State	:	VA
Zip	:	22801-4636
Country	:	US
Telephone Number	:	540-327-1385
Fax Number	:	540-304-3295

Provider Business Practice Location Address
First Line	:	1380 BLACKBERRY LN
Second Line	:
City	:	ROCKINGHAM
State	:	VA
Zip	:	22802-0901
Country	:	US
Telephone Number	:	540-534-4539
Fax Number	:	540-304-3295

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	04/28/2025

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