Healthcare Provider Details

I. General information

NPI: 1396166179
Provider Name (Legal Business Name): AMY KATHERINE BLITT CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY KATHERINE KIRK, COX CRNA

II. Dates (important events)

Enumeration Date: 12/23/2013
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3204
US

IV. Provider business mailing address

311 6TH ST SE APT 1
WASHINGTON DC
20003-2770
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax:
Mailing address:
  • Phone: 207-356-2748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA133029
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024179493
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: