Provider Demographics
NPI:1871983122
Name:BRAULT, KREGAN (CNM)
Entity type:Individual
Prefix:
First Name:KREGAN
Middle Name:
Last Name:BRAULT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6353 CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-4100
Mailing Address - Country:US
Mailing Address - Phone:561-486-8439
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:500 SENTARA CIR STE 105
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-5754
Practice Address - Country:US
Practice Address - Phone:757-253-5653
Practice Address - Fax:757-378-2776
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0001192181164W00000X
VA0024170653367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No164W00000XNursing Service ProvidersLicensed Practical Nurse