1043456213 NPI number — MRS. KYANA ANTHONY CRNP

Table of content: MRS. KYANA ANTHONY CRNP (NPI 1043456213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043456213 NPI number — MRS. KYANA ANTHONY CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANTHONY
Provider First Name:
KYANA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043456213
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43389 FRENCHMANS CREEK TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20147-7024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-977-2933
Provider Business Mailing Address Fax Number:
703-991-7440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2833 CLEAVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22042-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-969-1104
Provider Business Practice Location Address Fax Number:
703-398-1516
Provider Enumeration Date:
12/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  0024178759 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102236169 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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