1356844427 NPI number — KRISTINA MARIA MATTHEWS CNA, MA, QMHP

Table of content: KRISTINA MARIA MATTHEWS CNA, MA, QMHP (NPI 1356844427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356844427 NPI number — KRISTINA MARIA MATTHEWS CNA, MA, QMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
KRISTINA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNA, MA, QMHP
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:
1356844427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1206 LASKIN ROAD
Provider Second Line Business Mailing Address:
SUITE 140-G
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-807-7246
Provider Business Mailing Address Fax Number:
757-807-7248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 LASKIN ROAD
Provider Second Line Business Practice Location Address:
SUITE 140-G
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-807-7246
Provider Business Practice Location Address Fax Number:
757-807-7248
Provider Enumeration Date:
03/14/2018

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: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com