Provider Demographics
NPI:1174604656
Name:MARKHAM, KRISTIE LYNN (RNC, MED, MSN, FNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:LYNN
Last Name:MARKHAM
Suffix:
Gender:F
Credentials:RNC, MED, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 HAWTHORN ROAD
Mailing Address - Street 2:P.O. BOX 253
Mailing Address - City:BIG ISLAND
Mailing Address - State:VA
Mailing Address - Zip Code:24526
Mailing Address - Country:US
Mailing Address - Phone:434-299-5609
Mailing Address - Fax:
Practice Address - Street 1:2015 TATE SPRINGS RD LOWR LEVEL SUITE 2
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1111
Practice Address - Country:US
Practice Address - Phone:434-528-9075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily