Individual
KIMBERLY MCKISSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 EMANCIPATION DR, HAMPTON, VA 23667-3302
(757) 722-9961
Mailing address
3001 W MERCURY BLVD UNIT C, HAMPTON, VA 23666-3930
(757) 405-6060
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024173116
VA
363LP2300X
Primary Care Nurse Practitioner
Primary
0024173116
VA
363LW0102X
Women's Health Nurse Practitioner
APN0000018429
TN
Other
Enumeration date
05/29/2014
Last updated
08/20/2023
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