MEDICARE: MS. KRISTIN LYNN ECKLAND ACNP, BC, RNFA

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	363LA2100X	Acute Care Nurse Practitioner	61944	WV
2	363LA2100X	Acute Care Nurse Practitioner	PENDING	VI
3	363LA2100X	Acute Care Nurse Practitioner	AP4242	AZ
4	363LA2100X	Acute Care Nurse Practitioner	0024167225	VA
5	363LA2100X	Acute Care Nurse Practitioner	2005-01389	NC
6	363LA2100X	Acute Care Nurse Practitioner	APN0000011834	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11834	OTHER	TN	ADVANCED PRACTICE NURSE
2	2005009361-28	OTHER		NATIONAL CERTIFICATION
3	PENDING	OTHER	VI	NURSING LICENSE
4	61944	OTHER	WV	NURSING LICENSE/ ADVANCED
5	140397	OTHER	TN	RN LICENSE (NP PENDING)

General Provider Information

NPI Number	:	1508841370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTIN LYNN ECKLAND ACNP, BC, RNFA

Provider Business Mailing Address
First Line	:	213 S JEFFERSON ST STE 1006
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24011-1713
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 CRYSTAL SPRING AVE SW STE 201
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24014-2465
Country	:	US
Telephone Number	:	540-853-0100
Fax Number	:

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	01/09/2024

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