Provider Demographics
NPI:1649099862
Name:KLECKA, AUDREY CATHERINE (FNP-C)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:CATHERINE
Last Name:KLECKA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5302
Mailing Address - Country:US
Mailing Address - Phone:757-928-5082
Mailing Address - Fax:
Practice Address - Street 1:1005 COMMERCIAL LN STE 220
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8149
Practice Address - Country:US
Practice Address - Phone:757-668-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024191406OtherVIRGINIA BOARD OF NURSING LICENSE
F08240389OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS