Provider Demographics
NPI:1700397536
Name:GILCHRIST, ATIYA T (LPN)
Entity Type:Individual
Prefix:
First Name:ATIYA
Middle Name:T
Last Name:GILCHRIST
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10409 MARBURY TER
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3079
Mailing Address - Country:US
Mailing Address - Phone:804-878-1716
Mailing Address - Fax:
Practice Address - Street 1:10409 MARBURY TER
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3079
Practice Address - Country:US
Practice Address - Phone:804-878-1716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002066405164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0436171760Medicaid