Provider Demographics
NPI:1396200994
Name:RENEGAR, LAURA KATHRYN (PA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:KATHRYN
Last Name:RENEGAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:KATHRYN
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:1613 SUMMERALL LN APT 103
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-5217
Mailing Address - Country:US
Mailing Address - Phone:239-898-0025
Mailing Address - Fax:
Practice Address - Street 1:5544 GREENWICH RD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6563
Practice Address - Country:US
Practice Address - Phone:757-466-8017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant