Provider Demographics
NPI:1245220516
Name:PAULTER, KATHLEEN ANN (RN, FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:PAULTER
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8640 SUDLEY RD STE 303
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:703-361-7778
Mailing Address - Fax:703-361-1811
Practice Address - Street 1:8640 SUDLEY RD STE 303
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:703-361-7778
Practice Address - Fax:703-361-1811
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024165000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily