Healthcare Provider Details

I. General information

NPI: 1730019753
Provider Name (Legal Business Name): SIERRA SPRINGS INTEGRATED CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 WILDWOOD ST.
LORTON VA
22079
US

IV. Provider business mailing address

9200 WILDWOOD ST
LORTON VA
22079-1818
US

V. Phone/Fax

Practice location:
  • Phone: 703-863-4656
  • Fax:
Mailing address:
  • Phone: 703-863-4656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BINTOU KABA-HENDERSON
Title or Position: OWNER
Credential: NP
Phone: 703-863-4656