Basic Information
| Provider Information | |||||||||
| NPI: | 1457357444 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEATH | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 LAKE WRIGHT DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235021871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572135700 | ||||||||
| FaxNumber: | 7572135701 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 COLISEUM DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236665963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578279400 | ||||||||
| FaxNumber: | 7578279320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2005 | ||||||||
| LastUpdateDate: | 04/11/2008 | ||||||||
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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 | 363L00000X | 0024164295 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 27874N | 01 | VA | OPTIMA | OTHER |