Provider Demographics
NPI:1659852283
Name:TICHENOR, KALI (NP)
Entity Type:Individual
Prefix:
First Name:KALI
Middle Name:
Last Name:TICHENOR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W 10TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:FRONT ROYAL
Mailing Address - State:VA
Mailing Address - Zip Code:22630-2812
Mailing Address - Country:US
Mailing Address - Phone:540-779-7639
Mailing Address - Fax:540-634-6875
Practice Address - Street 1:315 W 10TH ST STE B
Practice Address - Street 2:
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2812
Practice Address - Country:US
Practice Address - Phone:540-779-7639
Practice Address - Fax:540-634-6875
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176561363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily