Provider Demographics
NPI:1871901272
Name:MCGUINESS, KRUTIKA Z (NP)
Entity type:Individual
Prefix:MRS
First Name:KRUTIKA
Middle Name:Z
Last Name:MCGUINESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:KRUTIKA
Other - Middle Name:
Other - Last Name:KOTVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:801 DAVIS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7008
Mailing Address - Country:US
Mailing Address - Phone:540-961-1591
Mailing Address - Fax:540-961-1592
Practice Address - Street 1:801 DAVIS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7008
Practice Address - Country:US
Practice Address - Phone:540-961-1591
Practice Address - Fax:540-961-1592
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376360122363LF0000X
VA0024172881363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSMM3278303OtherDEA