Provider Demographics
NPI:1043920606
Name:PEMBROKE, KRISTA (NP)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:PEMBROKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 CARMICHAEL WAY STE 604
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-2489
Mailing Address - Country:US
Mailing Address - Phone:757-908-2124
Mailing Address - Fax:757-908-2320
Practice Address - Street 1:200 CARMICHAEL WAY STE 604
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-2489
Practice Address - Country:US
Practice Address - Phone:757-908-2124
Practice Address - Fax:757-908-2320
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024185772363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health