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General NPI Number Information
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NPI Number | 1659667681
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Entity Type | Individual
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Provider Name | KRISTEN WHITE PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/28/2011
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 1500 COMMONWEALTH AVE
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5229
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Country | US
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Telephone | 757-585-2250
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Fax | 757-585-2061
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Provider Business Mailing Address
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Address Line | 856 J CLYDE MORRIS BLVD SUITE A
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-1318
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Country | US
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Telephone | 757-594-4006
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Fax | 757-534-5190
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110004061
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA2022-0030
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License Number State | NM
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