Healthcare Provider Details

I. General information

NPI: 1730628348
Provider Name (Legal Business Name): KRISTINA N. LACOUR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 CHAMPIONS WAY STE 600
SUFFOLK VA
23435-3763
US

IV. Provider business mailing address

1131 BEAUTIFUL ST
VIRGINIA BEACH VA
23451-5809
US

V. Phone/Fax

Practice location:
  • Phone: 757-538-7553
  • Fax: 757-263-0513
Mailing address:
  • Phone: 757-538-7553
  • Fax: 757-263-0513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190002
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001328114
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: