Provider Demographics
NPI:1285205765
Name:SPADARO, KAITLIN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:SPADARO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BROWNS WAY RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-9501
Mailing Address - Country:US
Mailing Address - Phone:724-972-3620
Mailing Address - Fax:
Practice Address - Street 1:230 BROWNS WAY RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-9501
Practice Address - Country:US
Practice Address - Phone:724-972-3620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181672363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily