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NPI Code Detail

MEDICARE: KREGAN BRAULT CNM

MEDICARE: KREGAN BRAULT CNM
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
1164W00000XLicensed Practical Nurse0001192181VA
2367A00000XAdvanced Practice Midwife0024170653VA

General Provider Information

NPI Number : 1871983122
Entity Type Code : Individual
Provider Name (Legal Business Name) : KREGAN BRAULT CNM
Provider Business Mailing Address
First Line : 6353 CENTER DR STE 100
Second Line :
City : NORFOLK
State : VA
Zip : 23502-4100
Country : US
Telephone Number : 561-486-8439
Fax Number : 757-232-8875
Provider Business Practice Location Address
First Line : 500 SENTARA CIR STE 105
Second Line :
City : WILLIAMSBURG
State : VA
Zip : 23188-5754
Country : US
Telephone Number : 757-253-5653
Fax Number : 757-378-2776
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2015
Last Update Date : 07/07/2022

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