Provider Demographics
NPI:1922825884
Name:ACTON, KRYSTAL MARIE
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:MARIE
Last Name:ACTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:BUMPASS
Mailing Address - State:VA
Mailing Address - Zip Code:23024-2316
Mailing Address - Country:US
Mailing Address - Phone:804-347-4245
Mailing Address - Fax:
Practice Address - Street 1:2621 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4308
Practice Address - Country:US
Practice Address - Phone:804-254-9735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185394364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist