KIMBERLY MCKISSACK (NPI# 1720490386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720490386 |
| Entity Type | Individual |
| Full Name | KIMBERLY MCKISSACK |
| Credential | NP |
| Practice Address |
100 Emancipation Dr Hampton VA 23667-3302 |
| Mailing Address |
367 Manning Ln Hampton VA 23666-5024 |
| Practice Telephone | 7577229961 |
| Mailing Telephone | 6155691661 |
| Enumeration Date | 2014-05-29 |
| Last Update Date | 2019-09-21 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
0024173116 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LW0102X |
Nurse Practitioner Specialization: Women's Health |
APN0000018429 | TN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
100 EMANCIPATION DR |
| City | HAMPTON |
| State | VA |
| Zip Code | 23667-3302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073518916 | Therese P Montoya | Physical Medicine & Rehabilitation | 100 Emancipation Dr, Hampton, VA 23667 | 2005-06-16 |
| 1285241570 | Larry N. Wootten | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-09-30 |
| 1487266631 | Jason Jemale Hall | Counselor | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-08-19 |
| 1790395085 | Caitlyn Moody | Pharmacist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-08-03 |
| 1639788268 | Shan S. Wong | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-07-29 |
| 1205454352 | Charity Seitz | Psychologist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-07-06 |
| 1629694617 | Michael William Olsavicky | Pharmacist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-06-25 |
| 1659997914 | John David Kauffman | Pharmacist | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-06-23 |
| 1790301406 | Lineisha Williams | Social Worker | 100 Emancipation Dr, Hampton, VA 23667-0001 | 2020-06-18 |
| 1215557335 | Katy Hughes Fedorko | Physician Assistant | 100 Emancipation Dr, Hampton, VA 23667-2906 | 2020-04-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124447388 | Brian Pho Bui | Psychiatry & Neurology | Hampton Veterans Affairs 100 Emancipation Dr, Hampton, VA 23667 | 2014-04-15 |
| 1275786741 | Melissa Ann Palka | Nurse Practitioner | Hampton Va Medical Center, 100 Emancipation Dr., Hampton, VA 23667 | 2008-10-28 |
| 1639107741 | Lawrence Monroe Brown Jr. | Social Worker | Hampton Vamc, 100 Emancipation Dr, Hampton, VA 23667 | 2006-06-29 |
| 1578528030 | Harold Steven Smuckler | Family Medicine | Department of Veterans Affairs, Primary Care, 100 Emancipation Lane, Hampton, VA 23667 | 2006-04-19 |
| 1013978451 | Donald Epstein | Psychologist | 1000 Emancipation Drive, Hampton, VA 23667 | 2006-03-28 |
| 1225098593 | Maryanne Schaeffer | Dietitian, Registered | 100 Emancipation Drive, Hampton, VA 23667 | 2006-03-23 |
| 1376074773 | Linda Carol Whitfield | Case Manager/Care Coordinator | 100 Emancipation Drive, Hampton, VA 23667 | 2017-03-27 |
| 1316217516 | Wallace Danny Johnson IIi | Occupational Therapist | 100 Emancipation Drive, Hampton, VA 23667 | 2012-01-04 |
| 1386929164 | Amber Mizuki | Dietitian, Registered | 100 Emancipation Drive, Bldg 116, Hampton, VA 23667 | 2011-10-12 |
| 1447549266 | Irene Nanghui Yi | Pharmacist | 100 Emancipation Dr., Hampton Vamc, Hampton, VA 23667 | 2011-04-01 |
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| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710498035 | Venesha Lorraine Scott | Nurse Practitioner | 12001 Lovejoy Crossing Blvd, Hampton, GA 30228-5985 | 2017-10-12 |
| 1790974723 | Mary J Gibson | Nurse Practitioner | 2117 Hartford Rd, Hampton, VA 23666-2408 | 2007-10-16 |
| 1124224746 | Wanda Renee Mcclellan | Nurse Practitioner | 402 South Lee Street, Hampton, AR 71744-0851 | 2007-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356948079 | Alissa Levine Wong | Nurse Practitioner | 8301 Arlington Blvd Ste 100, Fairfax, VA 22031-2902 | 2020-10-06 |
| 1912514209 | Kala Rutherford Stapleton | Nurse Practitioner | 1800 Combs Rd Ste 12, Pennington Gap, VA 24277-1808 | 2020-09-30 |
| 1689287583 | Teela J Walker | Nurse Practitioner | 250 Craftsman Cir, Suffolk, VA 23434-1530 | 2020-08-28 |
| 1093327876 | Jasmine Jones | Nurse Practitioner | 2828 Candlewood Cir, Chesapeake, VA 23324-3936 | 2020-08-21 |
| 1174140529 | Esther Chung | Nurse Practitioner | 9806 Gabon Ct, Burke, VA 22015-3111 | 2020-07-01 |
| 1346864725 | Karen Guidry | Nurse Practitioner | 2102 Broad Branch Cir, Richmond, VA 23238-6459 | 2020-06-02 |
| 1588285662 | Lindley Walker Abernathy | Nurse Practitioner | 25506 Courthouse Rd, Stony Creek, VA 23882-2042 | 2020-04-30 |
| 1952935777 | Janice Oh | Nurse Practitioner | 7700 Little River Tpke Ste 102, Annandale, VA 22003-2400 | 2020-03-02 |
| 1003449448 | Yasmine M Kletter | Nurse Practitioner | 15213 Addison Ln, Woodbridge, VA 22193-6223 | 2020-02-13 |
| 1770113763 | Amy Armstead | Nurse Practitioner | 620 Keswick Rd, Colonial Heights, VA 23834-1729 | 2020-01-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.