Healthcare Provider Details

I. General information

NPI: 1912489097
Provider Name (Legal Business Name): KRISTY R VEST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 HOSPITAL DR STE 7
GALAX VA
24333-2453
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 276-236-5181
  • Fax:
Mailing address:
  • Phone: 540-224-5715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0017145130
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176474
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: