Healthcare Provider Details

I. General information

NPI: 1104760529
Provider Name (Legal Business Name): KENDALL CHRISTIAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21170 ASHBY PONDS BLVD
ASHBURN VA
20147-6128
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-1999
  • Fax:
Mailing address:
  • Phone: 877-345-5300
  • Fax: 561-989-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011777
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: