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General NPI Number Information
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NPI Number | 1750678744
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Entity Type | Individual
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Provider Name | VALERIYA KHODUSH KIRNOS PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 11009 INGLESIDE PL STE 201
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City | RALEIGH
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State | NC
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Zip | 27614-6697
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Country | US
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Telephone | 919-844-4344
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Fax | 919-844-3244
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Provider Business Mailing Address
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Address Line | 2675 WINKLER AVE STE 200
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City | FORT MYERS
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State | FL
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Zip | 33901-9328
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Country | US
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Telephone | 877-856-3774
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Fax | 239-599-2612
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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 | 0010-02961
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License Number State | NC
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