Provider Demographics
NPI:1649259102
Name:RENZI, KRISTEN L (PA - C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:RENZI
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:KEENAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:
Practice Address - Street 1:1880 AMHERST STREET
Practice Address - Street 2:SUITE 100 AND SUITE 200
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-662-0306
Practice Address - Fax:855-264-2066
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110000777363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01176Medicare UPIN
VA970000347Medicare ID - Type UnspecifiedTRAILBLAZERS
VAP00057441Medicare ID - Type UnspecifiedRAILROAD MEDICARE