Provider Demographics
NPI:1164059887
Name:DONOVAN, KATHRYN ROSE (DO)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:DONOVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ROSE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:6900 FOREST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1730
Mailing Address - Country:US
Mailing Address - Phone:804-346-1515
Mailing Address - Fax:804-270-2888
Practice Address - Street 1:6900 FOREST AVE STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1730
Practice Address - Country:US
Practice Address - Phone:804-346-1515
Practice Address - Fax:804-270-2888
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012207768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine