Individual
KIMBERLY J MEDINA
Active
Individual
KIMBERLY J MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
150584
CT
163W00000X
Registered Nurse
RN641567
PA
163WC0200X
Critical Care Medicine Registered Nurse
RN641567
PA
363LA2100X
Acute Care Nurse Practitioner
Primary
SP022227
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
150584
CT BON
CT
01
—
RN2307770
MA BON
MA
01
—
RN641567
PA BON
PA
01
—
SP022227
LICENSE
PA
Enumeration date
04/13/2020
Last updated
02/03/2026
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