Individual
KRISTI VERGENA MIZELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
704 THIMBLE SHOALS BLVD, BLDG. 300 A, NEWPORT NEWS, VA 23606-4544
(757) 595-4300
(757) 591-9297
Mailing address
860 OMNI BLVD, SUITE 303, NEWPORT NEWS, VA 23606-4430
(757) 232-8769
(757) 232-8875
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
D73504
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051642200
—
MD
Enumeration date
02/05/2007
Last updated
06/20/2013
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