Healthcare Provider Details

I. General information

NPI: 1285553545
Provider Name (Legal Business Name): KRISTA ANTHONY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 RIXLEW LN STE 230
MANASSAS VA
20109-4278
US

IV. Provider business mailing address

203 HASTINGS DR
FREDERICKSBURG VA
22406-6469
US

V. Phone/Fax

Practice location:
  • Phone: 240-657-0364
  • Fax: 833-220-8662
Mailing address:
  • Phone: 540-878-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0133004136
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: