Provider Demographics
NPI:1306880422
Name:CONRAD, KRISTIN (CNM)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:CONRAD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 S MAIN ST
Mailing Address - Street 2:SUITE 704
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-6635
Mailing Address - Country:US
Mailing Address - Phone:540-961-1058
Mailing Address - Fax:540-961-1668
Practice Address - Street 1:1900 ELECTRIC RD STE 1030
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7474
Practice Address - Country:US
Practice Address - Phone:540-774-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO167478367A00000X
VA0024167315367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98482548Medicaid
VA0024167315Medicaid