Provider Demographics
NPI:1851119879
Name:KRAVET, SAMANTHA (PNP)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:KRAVET
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 N TROY ST APT 406
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2558
Mailing Address - Country:US
Mailing Address - Phone:860-866-7052
Mailing Address - Fax:
Practice Address - Street 1:6354 WALKER LN STE 210
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3255
Practice Address - Country:US
Practice Address - Phone:703-971-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191296363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics