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General NPI Number Information
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NPI Number | 1225607906
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Entity Type | Individual
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Provider Name | JAMES CHRISTOPHER KWIATKOWSKI PMHNP
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Gender | Male
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Dates
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Enumeration Date | 06/17/2021
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 1308 SHERWOOD AVE
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City | RICHMOND
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State | VA
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Zip | 23220-1210
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Country | US
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Telephone | 804-828-9179
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Fax |
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Provider Business Mailing Address
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Address Line | 5700 W GRACE ST STE 108
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City | RICHMOND
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State | VA
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Zip | 23226-1832
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Country | US
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Telephone | 804-442-3116
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024181648
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License Number State | VA
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