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General NPI Number Information
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NPI Number | 1598574949
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Entity Type | Individual
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Provider Name | KRISTEN WALL FNP
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Gender | Female
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 04/28/2025
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Provider Practice Location Address
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Address Line | 110 IRVING ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-3017
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Country | US
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Telephone | 202-877-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 200 LUNA PARK DR APT 149
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City | ALEXANDRIA
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State | VA
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Zip | 22305-3143
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Country | US
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Telephone | 860-508-1913
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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 | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | RN1061583
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AC007471
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License Number State | MD
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