Individual provider Active NPI

Kristina Ann Kinsella, PA

  • Physician Assistant
  • Virginia Beach, VA
National Provider Identifier
1750669768
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110004892 Issued in VA
Practice address
1975 Glenn Mitchell Dr Ste 202
Virginia Beach, VA 23456-0167
Phone
(757) 507-8610
NPI assigned
Jul 25, 2011
Last updated
May 30, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-06224 NC
Physician Assistant 363A00000X 014895 NY
Physician Assistant 363A00000X 0110004892 VA Primary

Addresses

Primary practice location

1975 Glenn Mitchell Dr Ste 202
Virginia Beach, VA 23456-0167

Mailing address

1975 Glenn Mitchell Dr Ste 202
Virginia Beach, VA 23456-0167
Phone (757) 507-8610

Other practice location 1

259 First Street
Mineola, NY 11501
Phone (516) 663-0333

Other practice location 2

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8000

Other practice location 3

2301 Erwin Rd
Durham, NC 27705-4699
Phone (919) 684-8111

Other names 1

  • Kristina A Kinsella Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, NC, VA3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20111018000504 NY Practitioner - Physician Assistant 2365614286 Reassigns benefits to 1 organization
I20170424000517 NC Practitioner - Physician Assistant 2365614286 Reassigns benefits to 2 organizations
I20221219002205 VA Practitioner - Physician Assistant 2365614286 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-06224NCMDPhysician Assistant
0110004892VAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wakemed Specialists Group LLC CurrentSince Aug 22, 2019 Accepting new patients
New York University CurrentSince Feb 23, 2019 Accepting new patients
Sentara Medical Group CurrentSince Jan 3, 2023 Accepting new patients
New York University CurrentSince Feb 23, 2019 Accepting new patients
Duke University Health System, Inc. CurrentSince Dec 7, 2020 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Aug 22, 2019 Accepting new patients
Duke University Health System, Inc. CurrentSince Dec 7, 2020 Accepting new patients

Locations

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

5213 S Alston Ave
Durham, NC 27713
Phone (919) 620-4700

6301 Herndon Rd
Durham, NC 27713
Phone (919) 571-6107

10000 Falls of Neuse Rd
Raleigh, NC 27614
Phone (919) 350-1300

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

1300 Franklin Ave
Ste ML6
Garden City, NY 11530
Phone (516) 353-1900

120 Mineola Blvd
Ste 600
Mineola, NY 11501
Phone (516) 663-4525

259 1st St
Mineola, NY 11501
Phone (516) 576-1820

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

1975 Glenn Mitchell Dr
Ste 202
Virginia Beach, VA 23456
Phone (757) 507-8610

Organizations & group practices 8

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

NPI Registry JSON

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

{
    "created_epoch": "1311552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1750669768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 GLENN MITCHELL DR STE 202",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234560167",
            "telephone_number": "757-507-8610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 GLENN MITCHELL DR STE 202",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234560167",
            "telephone_number": "757-507-8610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "259 First Street",
            "address_purpose": "LOCATION",
            "city": "Mineola",
            "state": "NY",
            "postal_code": "11501",
            "country_code": "US",
            "telephone_number": "516-663-0333",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3000 New Bern Ave",
            "address_purpose": "LOCATION",
            "city": "Raleigh",
            "state": "NC",
            "postal_code": "276101231",
            "country_code": "US",
            "telephone_number": "919-350-8000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2301 Erwin Rd",
            "address_purpose": "LOCATION",
            "city": "Durham",
            "state": "NC",
            "postal_code": "277054699",
            "country_code": "US",
            "telephone_number": "919-684-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KINSELLA",
        "first_name": "KRISTINA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-25",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06224",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014895",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110004892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "KINSELLA",
            "middle_name": "A",
            "credential": "PA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.