Basic Information
| Provider Information | |||||||||
| NPI: | 1497376768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KISTNER | ||||||||
| FirstName: | TONI | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1450 SACHEM PL | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229012554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172765661 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1240 LEE ST | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229080817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349249333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2020 | ||||||||
| LastUpdateDate: | 03/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 0024180509 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 163WX0200X | 0001236556 | VA | Y | Nursing Service Providers | Registered Nurse | Oncology |
No ID Information.