MEDICARE: KIMBERLY A HEATH NP

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	363L00000X	Nurse Practitioner	0024164295	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	27874N	OTHER	VA	OPTIMA

General Provider Information

NPI Number	:	1457357444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A HEATH NP

Provider Business Mailing Address
First Line	:	5900 LAKE WRIGHT DR
Second Line	:	SUITE 300
City	:	NORFOLK
State	:	VA
Zip	:	23502-1871
Country	:	US
Telephone Number	:	757-213-5700
Fax Number	:	757-213-5701

Provider Business Practice Location Address
First Line	:	3000 COLISEUM DR
Second Line	:	SUITE 104
City	:	HAMPTON
State	:	VA
Zip	:	23666-5963
Country	:	US
Telephone Number	:	757-827-9400
Fax Number	:	757-827-9320

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	04/11/2008

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Directions to “ KIMBERLY A HEATH NP” Practice Location

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