Provider Demographics
NPI:1477656023
Name:PRICE, KATHI LYNN (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHI
Middle Name:LYNN
Last Name:PRICE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 FRONT ST W
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-3607
Mailing Address - Country:US
Mailing Address - Phone:276-395-2389
Mailing Address - Fax:276-395-6634
Practice Address - Street 1:515 FRONT ST W
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-3607
Practice Address - Country:US
Practice Address - Phone:276-395-2389
Practice Address - Fax:276-395-6634
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164956363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100130340Medicaid
P00687791OtherRR MEDICARE
VA1477656023Medicaid
VA1477656023Medicaid
VA00X674N12Medicare PIN