Doctor Name: | KIMBERLY A WOOLLEY |
NPI Number: | 1184616260 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPNP |
License Number: | 563952 |
Business Practice Address: | 11 Mdg/bolling Afb 238 Brookley Ave Sw Bolling Afb, DC - 203320001 |
Business Phone Number: | 2024047747 |
Business Fax Number: | |
Mailing Address: | 465 Old Town Ct, ALEXANDRIA |
State: | VA |
Postal Code: | 223143545 |
Phone Number: | 7038380213 |
Fax Number: | |
NPI Enumeration Date: | 08/16/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | 563952 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |