Organization
KKCL HEALTHCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL K LAUER NP (AUTHORIZED OFFICIAL/OWNER)
(804) 441-0447
Entity
Organization
Contact information
Practice address
1527 SUNFLOWER FIELDS DR, RUCKERSVILLE, VA 22968-1510
(804) 441-0447
(804) 282-9135
Mailing address
1527 SUNFLOWER FIELDS DR, RUCKERSVILLE, VA 22968-1510
(804) 441-0447
(804) 282-9135
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/27/2019
Last updated
09/27/2019
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