Provider Demographics
NPI:1891566444
Name:KAWA, ABDUL ALPHA (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:ABDUL
Middle Name:ALPHA
Last Name:KAWA
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 ROLLINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-7268
Mailing Address - Country:US
Mailing Address - Phone:133-668-1288
Mailing Address - Fax:
Practice Address - Street 1:23 ROLLINGSIDE DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7268
Practice Address - Country:US
Practice Address - Phone:133-668-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189138363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care