Healthcare Provider Details

I. General information

NPI: 1710234943
Provider Name (Legal Business Name): KRISTYN C RUDISILL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTYN C GENTRY

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST INTERNAL MEDICINE
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

PO BOX 780125
PHILADELPHIA PA
19178-0125
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4571
  • Fax: 804-828-7710
Mailing address:
  • Phone: 804-922-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003975
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: