Individual
KIMBERLY REVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12300 WASHINGTON HWY, ASHLAND, VA 23005-7646
(804) 365-4195
Mailing address
12300 WASHINGTON HWY, ASHLAND, VA 23005-7646
(804) 365-4195
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002086795
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
111111111
HANOVER CSB
—
Enumeration date
01/05/2023
Last updated
01/05/2023
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