Healthcare Provider Details

I. General information

NPI: 1881133650
Provider Name (Legal Business Name): KRISTIN ELIZABETH MINNICK MSN, CNM, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIN MATEJCEK

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 MADISON CROSSING LN
VIRGINIA BEACH VA
23453-2272
US

IV. Provider business mailing address

1709 MADISON CROSSING LN
VIRGINIA BEACH VA
23453-2272
US

V. Phone/Fax

Practice location:
  • Phone: 304-839-7831
  • Fax:
Mailing address:
  • Phone: 360-475-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024188817
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0024188817
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: