Provider Demographics
NPI:1629598495
Name:MILLER, KRISTEN L (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:BITZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:825 FAIRFAX AVE
Mailing Address - Street 2:SUITE 563
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507
Mailing Address - Country:US
Mailing Address - Phone:757-446-8999
Mailing Address - Fax:
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:FLOOR
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1912
Practice Address - Country:US
Practice Address - Phone:757-446-8999
Practice Address - Fax:757-446-7922
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005815363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty