Provider Demographics
NPI:1447377338
Name:MCIRVIN, KRISTINA DAPHNE (FNP)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DAPHNE
Last Name:MCIRVIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S JEFFERSON FOREST LN
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-8985
Mailing Address - Country:US
Mailing Address - Phone:317-908-5079
Mailing Address - Fax:
Practice Address - Street 1:1997 S MAIN ST STE 703
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-6606
Practice Address - Country:US
Practice Address - Phone:276-235-3205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily