Basic Information
| Provider Information | |||||||||
| NPI: | 1073793592 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARNSWORTH | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11240 WAPLES MILL RD | ||||||||
| Address2: | SUITE 403 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220306078 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033836424 | ||||||||
| FaxNumber: | 7033850575 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 TOWN CENTER PKWY | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | RESTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201905851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7036890300 | ||||||||
| FaxNumber: | 7037879664 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2007 | ||||||||
| LastUpdateDate: | 11/13/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.