Provider Demographics
NPI:1124421573
Name:MCELHANEY, KRISTEN KEITH (PA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KEITH
Last Name:MCELHANEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:NICOLE
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:301 RIVERVIEW AVE STE 700
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1065
Mailing Address - Country:US
Mailing Address - Phone:757-252-9365
Mailing Address - Fax:757-962-7217
Practice Address - Street 1:301 RIVERVIEW AVE STE 700
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1065
Practice Address - Country:US
Practice Address - Phone:757-252-9365
Practice Address - Fax:757-962-7217
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1124421573Medicaid
VAVVF381AMedicare PIN