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General NPI Number Information
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NPI Number | 1548560519
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Entity Type | Individual
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Provider Name | KRISTIE RENEE WAGSTAFF WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 5801 HARBOUR VIEW BLVD # 300
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City | SUFFOLK
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State | VA
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Zip | 23435-2657
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Country | US
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Telephone | 757-673-8383
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Fax | 757-483-9350
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Provider Business Mailing Address
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Address Line | 109 PINTAIL DR
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City | SUFFOLK
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State | VA
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Zip | 23435-3724
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Country | US
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Telephone | 913-240-6203
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 0024190695
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 75273
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 2011009868
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License Number State | MO
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