Provider Demographics
NPI:1861897365
Name:SOUDER, KRISTIN SACHS (PA-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SACHS
Last Name:SOUDER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3241 WESTERN BRANCH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5260
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:3060 GODWIN BLVD
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-8274
Practice Address - Country:US
Practice Address - Phone:757-935-5310
Practice Address - Fax:757-935-5311
Is Sole Proprietor?:No
Enumeration Date:2014-10-27
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-004714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant