Healthcare Provider Details

I. General information

NPI: 1831347699
Provider Name (Legal Business Name): LEILA KISSICK DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2008
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 ASHLAKE PKWY STE 200
CHESTERFIELD VA
23832-2827
US

IV. Provider business mailing address

7300 ASHLAKE PKWY STE 200
CHESTERFIELD VA
23832-2827
US

V. Phone/Fax

Practice location:
  • Phone: 804-256-8282
  • Fax: 804-256-8288
Mailing address:
  • Phone: 804-256-8282
  • Fax: 804-256-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN134622
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5248
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9493958
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185864
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: