Organization
COMMONWEALTH PRIMARY CARE
Active
Other names
Commonwealth Extended Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KARISSA L. HACKELTON M.D. (MEDICAL DIRECTOR/PHYICIAN/SHAREHOLD)
(804) 285-7425
Entity
Organization
Contact information
Practice address
1800 GLENSIDE DR, SUITE 103, RICHMOND, VA 23226-3769
(804) 285-7425
(804) 673-7074
Mailing address
1800 GLENSIDE DR, SUITE 103, RICHMOND, VA 23226-3769
(804) 285-7425
(804) 673-7074
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024172915
VA
Other
Enumeration date
01/22/2016
Last updated
01/22/2016
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