MEDICARE: MRS. KEDEST GEBRESELASSIE FNP

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	0024173128	VA
2	363LF0000X	Family Nurse Practitioner	0024173128	VA

General Provider Information

NPI Number	:	1265897391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KEDEST GEBRESELASSIE FNP

Provider Business Mailing Address
First Line	:	46 S GLEBE RD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1655
Country	:	US
Telephone Number	:	703-841-0703
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 S GLEBE RD STE 300
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-1672
Country	:	US
Telephone Number	:	703-841-0703
Fax Number	:

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

Provider Enumeration Date	:	12/16/2015
Last Update Date	:	04/18/2026

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