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NPI Code Detail

MEDICARE: MS. KRISTEN WHITE PA-C

MEDICARE: MS. KRISTEN WHITE PA-C
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
1363AM0700XMedical Physician Assistant
2363AM0700XMedical Physician Assistant0110004061VA
3363A00000XPhysician AssistantPA2022-0030NM

General Provider Information

NPI Number : 1659667681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KRISTEN WHITE PA-C
Provider Business Mailing Address
First Line : 856 J CLYDE MORRIS BLVD
Second Line : SUITE A
City : NEWPORT NEWS
State : VA
Zip : 23601-1318
Country : US
Telephone Number : 757-594-4006
Fax Number : 757-534-5190
Provider Business Practice Location Address
First Line : 1500 COMMONWEALTH AVE
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23185-5229
Country : US
Telephone Number : 757-585-2250
Fax Number : 757-585-2061
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2011
Last Update Date : 05/17/2022

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