Provider Demographics
NPI:1063481406
Name:CRIPPEN, PAMELA A
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:CRIPPEN
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 1:2921 TELESTAR CT
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1205
Mailing Address - Country:US
Mailing Address - Phone:703-280-5858
Mailing Address - Fax:703-280-2654
Practice Address - Street 1:2921 TELESTAR CT
Practice Address - Street 2:SUITE 140
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1205
Practice Address - Country:US
Practice Address - Phone:703-280-5858
Practice Address - Fax:703-280-2654
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024085478363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010148545Medicaid
MD407359200Medicaid
MD407359200Medicaid
VA016671C44Medicare ID - Type Unspecified