Healthcare Provider Details

I. General information

NPI: 1679447213
Provider Name (Legal Business Name): KAYLA THOMPSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4503 PENWOOD DR
ALEXANDRIA VA
22310-1463
US

IV. Provider business mailing address

9245 JESSICA DR
MANASSAS PARK VA
20111-2486
US

V. Phone/Fax

Practice location:
  • Phone: 571-505-5615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024194668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: