Provider Demographics
NPI:1356514947
Name:DALEY, CHRISTINE KYLE (NP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:KYLE
Last Name:DALEY
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 1:4000 COLISEUM DR STE 445
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5981
Mailing Address - Country:US
Mailing Address - Phone:757-827-2127
Mailing Address - Fax:757-827-2255
Practice Address - Street 1:4000 COLISEUM DR STE 445
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5981
Practice Address - Country:US
Practice Address - Phone:757-827-2127
Practice Address - Fax:757-827-2255
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165783363LW0102X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356514947Medicaid
VAMC10030Medicare PIN
VAS47187Medicare UPIN
VA1356514947Medicaid