Provider Demographics
NPI:1902408826
Name:SHAFER, KINDRA LERAE (RN)
Entity Type:Individual
Prefix:
First Name:KINDRA
Middle Name:LERAE
Last Name:SHAFER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BRICKHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:POQUOSON
Mailing Address - State:VA
Mailing Address - Zip Code:23662-1902
Mailing Address - Country:US
Mailing Address - Phone:757-876-6078
Mailing Address - Fax:
Practice Address - Street 1:8 BRICKHOUSE RD
Practice Address - Street 2:
Practice Address - City:POQUOSON
Practice Address - State:VA
Practice Address - Zip Code:23662-1902
Practice Address - Country:US
Practice Address - Phone:757-876-6078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001238729163WX0003X
VA0024183255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient