MEDICARE: DAVID KRUKIEL PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024181592	VA
2	163WP0808X	Psychiatric/Mental Health Registered Nurse	0001259386	VA

General Provider Information

NPI Number	:	1184207680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KRUKIEL PMHNP

Provider Business Mailing Address
First Line	:	2808 FOX CHASE LN
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112-4008
Country	:	US
Telephone Number	:	804-303-9622
Fax Number	:	804-716-4318

Provider Business Practice Location Address
First Line	:	7201 GLEN FOREST DR STE 304
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-3759
Country	:	US
Telephone Number	:	804-303-9622
Fax Number	:	804-716-4318

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	05/18/2026

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