Provider Demographics
NPI:1528042199
Name:CAVANAUGH, KATHY M (NP)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:M
Last Name:CAVANAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1010
Mailing Address - Country:US
Mailing Address - Phone:540-344-1400
Mailing Address - Fax:540-985-0325
Practice Address - Street 1:2602 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1010
Practice Address - Country:US
Practice Address - Phone:540-344-1400
Practice Address - Fax:540-985-0325
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024164610207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA001450P08Medicare ID - Type Unspecified
P88170Medicare UPIN