Provider Demographics
NPI:1164782009
Name:CROSS, NANCY KANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:KANE
Last Name:CROSS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 CHAIN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4080
Mailing Address - Country:US
Mailing Address - Phone:703-246-4992
Mailing Address - Fax:703-352-0217
Practice Address - Street 1:4080 CHAIN BRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4080
Practice Address - Country:US
Practice Address - Phone:703-246-4992
Practice Address - Fax:703-352-0217
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant