Provider Demographics
NPI:1558234633
Name:KO, KRISTIN ARA (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ARA
Last Name:KO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6354 WALKER LN STE 300
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3252
Mailing Address - Country:US
Mailing Address - Phone:703-810-5210
Mailing Address - Fax:703-810-5418
Practice Address - Street 1:6354 WALKER LN STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3252
Practice Address - Country:US
Practice Address - Phone:703-810-5210
Practice Address - Fax:703-810-5418
Is Sole Proprietor?:No
Enumeration Date:2025-09-25
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110011103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant