Healthcare Provider Details

I. General information

NPI: 1174604656
Provider Name (Legal Business Name): KRISTIE LYNN MARKHAM RNC, MED, MSN, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 TATE SPRINGS RD LOWR LEVEL SUITE 2
LYNCHBURG VA
24501-1111
US

IV. Provider business mailing address

1129 HAWTHORN ROAD P.O. BOX 253
BIG ISLAND VA
24526
US

V. Phone/Fax

Practice location:
  • Phone: 434-528-9075
  • Fax:
Mailing address:
  • Phone: 434-299-5609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166116
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: