Provider Demographics
NPI:1053969618
Name:CALLAWAY, KRISTY (RN)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:
Last Name:CALLAWAY
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 1:1545 CROSSWAYS BLVD STE 268
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-0205
Mailing Address - Country:US
Mailing Address - Phone:757-756-6406
Mailing Address - Fax:
Practice Address - Street 1:1545 CROSSWAYS BLVD STE 268
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0205
Practice Address - Country:US
Practice Address - Phone:757-756-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001246833163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health