Healthcare Provider Details

I. General information

NPI: 1184207680
Provider Name (Legal Business Name): DAVID KRUKIEL PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7201 GLEN FOREST DR STE 304
RICHMOND VA
23226-3759
US

IV. Provider business mailing address

2808 FOX CHASE LN
MIDLOTHIAN VA
23112-4008
US

V. Phone/Fax

Practice location:
  • Phone: 804-303-9622
  • Fax: 804-716-4318
Mailing address:
  • Phone: 804-303-9622
  • Fax: 804-716-4318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024181592
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001259386
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: