Healthcare Provider Details

I. General information

NPI: 1417678749
Provider Name (Legal Business Name): KRISTY A WADE DNP,APRN,PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTY A WADE DNP, APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 RICHMOND HWY STE 201
STAFFORD VA
22554-7286
US

IV. Provider business mailing address

2052 RICHMOND HWY STE 201
STAFFORD VA
22554-7286
US

V. Phone/Fax

Practice location:
  • Phone: 540-699-0226
  • Fax: 540-699-0224
Mailing address:
  • Phone: 540-699-0226
  • Fax: 540-699-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024185007
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: