Provider Demographics
NPI:1093796146
Name:JUSTUS, KATHY JO (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:JO
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2377
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266-2377
Mailing Address - Country:US
Mailing Address - Phone:276-889-3700
Mailing Address - Fax:276-889-5505
Practice Address - Street 1:495 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266-1100
Practice Address - Country:US
Practice Address - Phone:276-889-3700
Practice Address - Fax:276-889-5505
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166373363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093796146Medicaid
VA010261295Medicaid
VA006748C55Medicare PIN
VAVV4354CMedicare PIN
VA010261295Medicaid