Individual
KIMBERLY TANNER FAVA
Active
Individual
KIMBERLY TANNER FAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHCNP, APRN
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R854373
MS
363LF0000X
Family Nurse Practitioner
854373
MS
363LW0102X
Women's Health Nurse Practitioner
Primary
854373
MS
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
R854373
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3459830
—
MS
Enumeration date
06/02/2008
Last updated
03/03/2026
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