Provider Demographics
NPI:1275574279
Name:MCDOWELL, KRISTIE F (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:F
Last Name:MCDOWELL
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 1:2602 MELISSA CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8069
Mailing Address - Country:US
Mailing Address - Phone:540-899-8877
Mailing Address - Fax:540-735-8097
Practice Address - Street 1:11131 JOURNAL PARKWAY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485
Practice Address - Country:US
Practice Address - Phone:540-775-8009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001953363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010284872Medicaid
P00237442OtherRAILROAD MEDICARE
P00237442OtherRAILROAD MEDICARE
007613F01Medicare PIN