Individual provider Active NPI

Kimberly Ann Kinney, FNP

  • Nurse Practitioner
  • Fairfax, VA
National Provider Identifier
1053900035
Registry record updated May 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024183881 Issued in VA
Practice address
8081 Innovation Park Dr Ste 301
Fairfax, VA 22031-4867
Phone
(571) 472-6431
Fax
(571) 665-6826
NPI assigned
Jan 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 28121186A IN
Nurse Practitioner 363L00000X 0024183881 VA Primary

Addresses

Primary practice location

8081 Innovation Park Dr Ste 301
Fairfax, VA 22031-4867

Mailing address

11887 Avedon Dr
Zionsville, IN 46077-6201
Phone (765) 860-2839

Other practice location 1

3300 Gallows Rd
Falls Church, VA 22042-3307
Phone (703) 776-4001

Other practice location 2

2001 W 86th St
Indianapolis, IN 46260-1991
Phone (765) 860-2839

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210312000290 IN Practitioner - Nurse Practitioner 4284040429 Reassigns benefits to 1 organization
I20220610001043 VA Practitioner - Nurse Practitioner 4284040429 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Vincent Medical Group IncGroup PAC ID 7012047640, 728 clinicians

Practice addresses (Care Compare)

8333 Naab Rd
230 Ascension Medical Group St. Vincent
Indianapolis, IN 46260-5924
Phone (317) 415-6580

Hospital & facility affiliations

  • Ascension St Vincent Hospital Hospital, Indianapolis, IN, CCN 150084

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0024183881VAMDNurse Practitioner
28121186AINMDFamily Nurse Practitioner

Interoperability endpoints

  • Direct secure messaging: kimberly.kinney.1@7598.direct.athenahealth.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653609600000",
    "number": "1053900035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11887 AVEDON DR",
            "city": "ZIONSVILLE",
            "state": "IN",
            "postal_code": "460776201",
            "telephone_number": "765-860-2839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8081 INNOVATION PARK DR STE 301",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314867",
            "telephone_number": "571-472-6431",
            "fax_number": "571-665-6826"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3300 Gallows Rd",
            "address_purpose": "LOCATION",
            "city": "Falls Church",
            "state": "VA",
            "postal_code": "220423307",
            "country_code": "US",
            "telephone_number": "703-776-4001",
            "fax_number": "703-776-7113",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2001 W 86th St",
            "address_purpose": "LOCATION",
            "city": "Indianapolis",
            "state": "IN",
            "postal_code": "462601991",
            "country_code": "US",
            "telephone_number": "765-860-2839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KINNEY",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-13",
        "last_updated": "2022-05-27",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IN",
            "license": "28121186A",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024183881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.