Provider Demographics
NPI:1518010503
Name:NIEDERER, KATHRYN K (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:K
Last Name:NIEDERER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 SHRADER RD
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4215
Mailing Address - Country:US
Mailing Address - Phone:804-288-1953
Mailing Address - Fax:
Practice Address - Street 1:7702 E PARHAM RD
Practice Address - Street 2:MOB III SUITE 102
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4371
Practice Address - Country:US
Practice Address - Phone:804-346-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-21
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003945363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant