Provider Demographics
NPI:1568862688
Name:HARLEY, KRISTI A
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:A
Last Name:HARLEY
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 1:500 DISCOVERY DR STE 302
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3871
Mailing Address - Country:US
Mailing Address - Phone:757-668-2500
Mailing Address - Fax:757-668-2510
Practice Address - Street 1:500 DISCOVERY DR STE 302
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3871
Practice Address - Country:US
Practice Address - Phone:757-668-2500
Practice Address - Fax:757-668-2510
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171919363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics