Healthcare Provider Details

I. General information

NPI: 1447120126
Provider Name (Legal Business Name): KRISTIE FELICKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 FIRST COLONIAL RD
VIRGINIA BEACH VA
23454-3002
US

IV. Provider business mailing address

710 BASNIGHT CT
CHESAPEAKE VA
23322-8312
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number0136000434
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: