Healthcare Provider Details

I. General information

NPI: 1679540231
Provider Name (Legal Business Name): KRISTIN HUYSMAN GRABILL PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1933 EDWIN DR STE 208
CHESAPEAKE VA
23322-6531
US

IV. Provider business mailing address

1933 EDWIN DR STE 208
CHESAPEAKE VA
23322-6531
US

V. Phone/Fax

Practice location:
  • Phone: 757-252-5820
  • Fax: 757-963-9609
Mailing address:
  • Phone: 757-252-5820
  • Fax: 757-963-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001726
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: