Provider Demographics
NPI:1568624054
Name:SHEARER, KATHLEEN (ANP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:SHEARER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5895 TRINITY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1995
Mailing Address - Country:US
Mailing Address - Phone:703-802-2004
Mailing Address - Fax:703-802-2113
Practice Address - Street 1:5895 TRINITY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1995
Practice Address - Country:US
Practice Address - Phone:703-802-2004
Practice Address - Fax:703-802-2113
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017001302363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0017001302OtherLICENSED AUTHORIZATION TO PRESCRIBE
VA0024052576OtherADULT NURSE PRACTITIONER