Basic Information
| Provider Information | |||||||||
| NPI: | 1033837059 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | KIMBERLY | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 615 ELSINORE PL | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452021459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8335104357 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4140 CROSSINGS CT STE 101-103 | ||||||||
| Address2: | |||||||||
| City: | PRINCE GEORGE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 238751538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576959406 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2022 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 0024184664 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.