Provider Demographics
NPI:1679758809
Name:NICOLL, KIMBERLY LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LYNN
Last Name:NICOLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 WESTPARK DRIVE
Mailing Address - Street 2:TYSONS CORNER MEDICAL CENTER
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102
Mailing Address - Country:US
Mailing Address - Phone:703-287-6633
Mailing Address - Fax:
Practice Address - Street 1:8008 WESTPARK DRIVE
Practice Address - Street 2:TYSONS CORNER MEDICAL CENTER
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102
Practice Address - Country:US
Practice Address - Phone:703-287-6633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program