Healthcare Provider Details

I. General information

NPI: 1033353602
Provider Name (Legal Business Name): KRISTINA MARIE WAUGH FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA WAUGH DAVIS FNP-C

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 03/04/2021
Certification Date: 03/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E JUBAL EARLY DR
WINCHESTER VA
22601-5178
US

IV. Provider business mailing address

258 TOP MEADOW LN
BERKELEY SPRINGS WV
25411-6662
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-2232
  • Fax:
Mailing address:
  • Phone: 304-261-0495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168248
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: