Provider Demographics
NPI:1699720953
Name:POWELL, KRISTINA N (MD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:N
Last Name:POWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 BULIFANTS BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-5747
Mailing Address - Country:US
Mailing Address - Phone:757-564-7337
Mailing Address - Fax:
Practice Address - Street 1:119 BULIFANTS BLVD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5709
Practice Address - Country:US
Practice Address - Phone:757-564-7337
Practice Address - Fax:757-564-3205
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101234857208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
54-1778786OtherFIRST HEALTH/MAIL HANDLER
7667523OtherAETNA- TRADITIONAL
54-1778786-032OtherCHAMPUS/TRICARE
54-1778786OtherVA HEALTH NETWORK
010126037OtherVA PREMIERE HEALTH PLAN
1110540OtherCIGNA
VT010126037Medicaid
153982OtherANTHEM
54-1778786OtherPHCS
54-1778786OtherMID ATLANTIC HEALTH SOLUT
12-03098OtherUNITED HEALTHCARE
25362OtherSENTARA/OPTIMA
3416381OtherAETNA HMO
54-1778786OtherSOUTHER HEALTH
8128045OtherMAMSI/MDIPA
54-1778786OtherCCN
54-1778786OtherVA HEALTH NETWORK