Individual
KIMBERLY A SOUTHAM-GEROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
2305 N PARHAM RD STE 3, RICHMOND, VA 23229-3156
(804) 263-4365
Mailing address
1215 WARREN AVE, RICHMOND, VA 23227-3739
(804) 263-3265
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024178278
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024178278
BOARD OF NURSING
VA
Enumeration date
09/23/2019
Last updated
08/20/2020
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