Provider Demographics
NPI:1356574867
Name:KASUN, REGINA JOANNE (ANP)
Entity type:Individual
Prefix:MS
First Name:REGINA
Middle Name:JOANNE
Last Name:KASUN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PROSPERITY AVE
Mailing Address - Street 2:STE 270
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4321
Mailing Address - Country:US
Mailing Address - Phone:703-836-8838
Mailing Address - Fax:
Practice Address - Street 1:2729 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-4008
Practice Address - Country:US
Practice Address - Phone:703-836-8838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC000779363LA2200X
VA0024168441363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health