Provider Demographics
NPI:1588890545
Name:AINSLEY, KRYSTAL E (MD)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:E
Last Name:AINSLEY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:
Practice Address - Street 1:120 KINGS WAY
Practice Address - Street 2:SUITE 1400
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2505
Practice Address - Country:US
Practice Address - Phone:757-345-2555
Practice Address - Fax:757-345-0366
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2016-05-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101251138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV5925AMedicare PIN
VA1588890545Medicaid
VAP01090265Medicare PIN