Individual
KARISSA L HACKELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1800 GLENSIDE DR, SUITE 110, RICHMOND, VA 23226-3769
(804) 288-1800
(804) 288-0515
Mailing address
1800 GLENSIDE DR, SUITE 105, RICHMOND, VA 23226-3769
(804) 288-0399
(804) 285-0088
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101236653
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1740341841
—
VA
Enumeration date
12/12/2006
Last updated
09/19/2011
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