Provider Demographics
NPI:1255392528
Name:WILLIAMS EAGLETON, KIA MARIE (MSN ANP BC)
Entity type:Individual
Prefix:
First Name:KIA
Middle Name:MARIE
Last Name:WILLIAMS EAGLETON
Suffix:
Gender:F
Credentials:MSN ANP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22402-1460
Mailing Address - Country:US
Mailing Address - Phone:540-786-2100
Mailing Address - Fax:540-786-0677
Practice Address - Street 1:3180 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4583
Practice Address - Country:US
Practice Address - Phone:703-538-2065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11038918363LA2200X
PATP005897X363LA2200X
MDAC007562363LA2200X
DCNP200001473363LA2200X
NJ26NN08813900363LA2200X
VA0024171616363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1255392528Medicaid
NJ08813900OtherSTATE LICENSE
VA1255392528Medicare PIN