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NPI Code Detail

MEDICARE: VIRGINIA KITCHEN FNP

MEDICARE: VIRGINIA KITCHEN 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
1363L00000XNurse Practitioner5014779NC
2363LF0000XFamily Nurse Practitioner5014779NC

General Provider Information

NPI Number : 1447823414
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIRGINIA KITCHEN FNP
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number : 704-446-6217
Provider Business Practice Location Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5812
Country : US
Telephone Number : 704-512-5363
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2021
Last Update Date : 03/05/2026

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Directions to “ VIRGINIA KITCHEN FNP” Practice Location

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