Healthcare Provider Details

I. General information

NPI: 1255392528
Provider Name (Legal Business Name): KIA MARIE WILLIAMS EAGLETON MSN ANP BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 FAIRVIEW PARK DR
FALLS CHURCH VA
22042-4583
US

IV. Provider business mailing address

PO BOX 1460
FREDERICKSBURG VA
22402-1460
US

V. Phone/Fax

Practice location:
  • Phone: 703-538-2065
  • Fax:
Mailing address:
  • Phone: 540-786-2100
  • Fax: 540-786-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11038918
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberTP005897X
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAC007562
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP200001473
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NN08813900
License Number StateNJ
# 6
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024171616
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: