Provider Demographics
NPI:1235315664
Name:EAGLE, KATHRYN ROSE (LDO)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ROSE
Last Name:EAGLE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 TINKERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:VA
Mailing Address - Zip Code:24555-2962
Mailing Address - Country:US
Mailing Address - Phone:540-291-3373
Mailing Address - Fax:540-291-3373
Practice Address - Street 1:166 TINKERVILLE RD
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:VA
Practice Address - Zip Code:24555-2962
Practice Address - Country:US
Practice Address - Phone:540-291-3373
Practice Address - Fax:540-291-3373
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101003356171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor