Provider Demographics
NPI:1184100018
Name:MCKAY, KIRSTIN MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:MARIE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 SAPPONY RD
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-1658
Mailing Address - Country:US
Mailing Address - Phone:804-929-8504
Mailing Address - Fax:
Practice Address - Street 1:411 W. RANDOLPH ROAD
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:VA
Practice Address - Zip Code:23860
Practice Address - Country:US
Practice Address - Phone:804-541-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2020-03-09
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-03-09
Provider Licenses
StateLicense IDTaxonomies
VA0001185437163W00000X
VA0024176400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse