Healthcare Provider Details

I. General information

NPI: 1699720953
Provider Name (Legal Business Name): KRISTINA N POWELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 02/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BULIFANTS BLVD
WILLIAMSBURG VA
23188-5709
US

IV. Provider business mailing address

119 BULIFANTS BLVD
WILLIAMSBURG VA
23188-5747
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-7337
  • Fax: 757-564-3205
Mailing address:
  • Phone: 757-564-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234857
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: