Provider Demographics
NPI:1679540231
Name:GRABILL, KRISTIN HUYSMAN (PA C)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:HUYSMAN
Last Name:GRABILL
Suffix:
Gender:
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 EDWIN DR STE 208
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322-6531
Mailing Address - Country:US
Mailing Address - Phone:757-252-5820
Mailing Address - Fax:757-963-9609
Practice Address - Street 1:1933 EDWIN DR STE 208
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23322-6531
Practice Address - Country:US
Practice Address - Phone:757-252-5820
Practice Address - Fax:757-963-9609
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001726363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010140285Medicaid
003044S33Medicare ID - Type Unspecified
VA010140285Medicaid