Provider Demographics
NPI:1457557449
Name:KENNEDY, CHRISTINE (ANP)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:KENNEDY
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 1:8640 SUDLEY ROAD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:703-361-7778
Mailing Address - Fax:703-361-1811
Practice Address - Street 1:8640 SUDLEY ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:703-361-7778
Practice Address - Fax:703-361-7778
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024074701363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health