Kimberly McKissack, NP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

0024173116 Issued in VA

Practice address

100 Emancipation Dr
Hampton, VA 23667-3302

Phone

(757) 722-9961

NPI assigned

May 29, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Enchanted Hills Health and Wellness Center LLC

  • Primary Care Nurse Practitioner
  • Newport News, VA
  • NPI 1437905155
  NPD Authorized official

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

{
    "created_epoch": "1401321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692489600000",
    "number": "1720490386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 W MERCURY BLVD UNIT C",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236663930",
            "telephone_number": "757-405-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 EMANCIPATION DR",
            "city": "HAMPTON",
            "state": "VA",
            "postal_code": "236673302",
            "telephone_number": "757-722-9961"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3001 W Mercury Blvd Unit C",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236663930",
            "country_code": "US",
            "telephone_number": "757-405-6060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKISSACK",
        "first_name": "KIMBERLY",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-29",
        "last_updated": "2023-08-20",
        "certification_date": "2023-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "VA",
            "license": "0024173116",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024173116",
            "primary": false
        },
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TN",
            "license": "APN0000018429",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Edward McKenna, PA-C
• Taylor Jean McKenzie, PHARMD
• Jacob Dakota McKillop, PA
• Susan Ruth McKinley, RN
• Regina McKinney, CRNA
• Christine McLean, DIETARY MANAGER
• Daveon Johnardo McMullen, PSYD
• Kezia McNair
• Gregory McPheter, CRNA
• Ryan G McQueen, M.D.

• Primary Care Nurse Practitioner in Hampton, VA
• Providers in Hampton, VA by specialty
• Primary Care Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.