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General NPI Number Information
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NPI Number | 1265228795
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Entity Type | Individual
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Provider Name | KENZIE DITTMAR PA
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Gender | Female
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Dates
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Enumeration Date | 04/21/2025
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1101 SAM PERRY BLVD STE 121
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-4465
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Country | US
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Telephone | 540-899-1600
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 N AMANDA CIR NE
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City | ATLANTA
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State | GA
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Zip | 30329-3320
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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