Healthcare Provider Details

I. General information

NPI: 1013966241
Provider Name (Legal Business Name): KRISTEN AULENBACH RUPELL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2006
Last Update Date: 02/21/2025
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS ROAD DEPARTMENT OF SURGERY
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

3300 GALLOWS ROAD DEPARTMENT OF SURGERY
FALLS CHURCH VA
22042
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-5438
  • Fax:
Mailing address:
  • Phone: 703-776-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001617
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110001617
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: