Individual provider Active NPI

Anna Kovalcik, NP

  • Pediatric Nurse Practitioner
  • Fairfax, VA
National Provider Identifier
1720655673
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
0024191032 Issued in VA
Practice address
13135 Route 50 Ste 201
Fairfax, VA 22033-1907
Phone
(703) 391-0900
NPI assigned
Jun 9, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 0024191032 VA Primary

Addresses

Primary practice location

13135 Route 50 Ste 201
Fairfax, VA 22033-1907

Mailing address

13135 Route 50 Ste 201
Fairfax, VA 22033-1907

Other practice location 1

22850 Brambleton Plz Ste 300
Brambleton, VA 20148-4933
Phone (703) 391-0900

Other practice location 2

6211 Centreville Rd Ste 100
Centreville, VA 20121-2641
Phone (703) 391-0900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024191032VAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Pediatricians & Assoc PastSince Feb 9, 2025 Accepting new patients
Trusted Doctors LLC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1720655673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13135 ROUTE 50 STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13135 ROUTE 50 STE 201",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331907",
            "telephone_number": "703-391-0900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22850 Brambleton Plz Ste 300",
            "address_purpose": "LOCATION",
            "city": "Brambleton",
            "state": "VA",
            "postal_code": "201484933",
            "country_code": "US",
            "telephone_number": "703-391-0900",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6211 Centreville Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Centreville",
            "state": "VA",
            "postal_code": "201212641",
            "country_code": "US",
            "telephone_number": "703-391-0900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOVALCIK",
        "first_name": "ANNA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-09",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "VA",
            "license": "0024191032",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; 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.