Kristine Rebecca Freeman, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110006625 Issued in VA

Practice address

8503 Arlington Blvd Ste 400
Fairfax, VA 22031

Phone

(703) 280-5390

Fax

(703) 280-9596

NPI assigned

Dec 3, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kristine Rebecca Gauthier Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1689071805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3040 WILLIAMS DR STE 100",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314618",
            "telephone_number": "571-350-8400",
            "fax_number": "703-940-8692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8503 ARLINGTON BLVD STE 400",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "22031",
            "telephone_number": "703-280-5390",
            "fax_number": "703-280-9596"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "450 Brookline Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "022155418",
            "country_code": "US",
            "telephone_number": "509-521-8282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "KRISTINE",
        "middle_name": "REBECCA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-03",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110006625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1689071805",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINE",
            "last_name": "GAUTHIER",
            "middle_name": "REBECCA",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Loretta Fredericks, LCSW
• Ryan Fredrickson, PSY.D.
• Kevin Ryan Free, PA-C
• Julia Helen Nyhuis Freed, FNP, RN, MSN
• Tingting Zhu Freed, DMD
• Vanessa Freeman, MD
• Lauren Rebecca Freeny, AU.D, CCC-A
• Katrina Freking, RNFA
• Kathleen Brelsford French, MD
• Mila Denise French, PH.D.

• Physician Assistant in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.