Provider Demographics
NPI:1962265546
Name:HALL, KENIA ISABEL (NP)
Entity type:Individual
Prefix:
First Name:KENIA
Middle Name:ISABEL
Last Name:HALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KENIA
Other - Middle Name:ISABEL
Other - Last Name:RUEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3023 HAMAKER CT STE 200
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2240
Mailing Address - Country:US
Mailing Address - Phone:703-848-6610
Mailing Address - Fax:571-206-1236
Practice Address - Street 1:8081 INNOVATION PARK DR STE 765
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-1717
Practice Address - Fax:571-472-1718
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185213363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner