MEDICARE: GRACE E KIM DNP, APRN, FNP-BC

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	363LF0000X	Family Nurse Practitioner	0024196240	VA

General Provider Information

NPI Number	:	1952251332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE E KIM DNP, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	8228 CARRLEIGH PKWY
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8228 CARRLEIGH PKWY
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1726
Country	:	US
Telephone Number	:	571-364-4993
Fax Number	:

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

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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