Healthcare Provider Details

I. General information

NPI: 1659874535
Provider Name (Legal Business Name): KIRSTEN YEZZI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 FOREST AVE STE 400
RICHMOND VA
23230-1726
US

IV. Provider business mailing address

7001 FOREST AVE STE 400
RICHMOND VA
23230-1726
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-7135
  • Fax:
Mailing address:
  • Phone: 804-282-0831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110006051
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: