Individual
MS. KENYA MICHELLE WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
3700 FETTLER PARK DR, DUMFRIES, VA 22025-2050
(703) 441-7655
Mailing address
28 CHRISTOPHER WAY, STAFFORD, VA 22554-7811
(540) 658-9127
(540) 658-9127
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024174942
VA
363LP0200X
Pediatric Nurse Practitioner
5005514
NC
Other
Enumeration date
03/12/2012
Last updated
07/21/2022
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