MEDICARE: KIA MARIE WILLIAMS EAGLETON MSN ANP BC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	APRN11038918	FL
2	363LA2200X	Adult Health Nurse Practitioner	TP005897X	PA
3	363LA2200X	Adult Health Nurse Practitioner	AC007562	MD
4	363LA2200X	Adult Health Nurse Practitioner	NP200001473	DC
5	363LA2200X	Adult Health Nurse Practitioner	26NN08813900	NJ
6	363LA2200X	Adult Health Nurse Practitioner	0024171616	VA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	08813900	OTHER	NJ	STATE LICENSE

NPI Number	:	1255392528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIA MARIE WILLIAMS EAGLETON MSN ANP BC

Provider Business Mailing Address
First Line	:	PO BOX 1460
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22402-1460
Country	:	US
Telephone Number	:	540-786-2100
Fax Number	:	540-786-0677

Provider Business Practice Location Address
First Line	:	3180 FAIRVIEW PARK DR
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22042-4583
Country	:	US
Telephone Number	:	703-538-2065
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	08/15/2025

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: