Provider Demographics
NPI:1215352554
Name:CHURCH, KINIYA CHANTERA (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:DR
First Name:KINIYA
Middle Name:CHANTERA
Last Name:CHURCH
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14321 WINTER BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14321 WINTER BREEZE DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2452
Practice Address - Country:US
Practice Address - Phone:833-452-9772
Practice Address - Fax:888-442-6953
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171501363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04555OtherGROUP PTAN
VAC05149OtherGROUP PTAN
VAC05403OtherGROUP PTAN
VAGC1103OtherGROUP PTAN