Provider Demographics
NPI:1578009775
Name:TOLMIE, KATHRYN LYON (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:LYON
Last Name:TOLMIE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005606363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1578009775OtherCOVENTRY/AETNA BETTER HEALTH
VA1578009775OtherCCCP VIRGINIA PREMIER
VA1578009775OtherUNITED MINE WORKERS ASSOCIATION
VA1578009775OtherAETNA
VA1578009775OtherTRICARE
VA1578009775OtherINTOTAL
VA1578009775OtherOPTIMA HEALTH PLAN
VA1578009775OtherMAGELLAN CCP
VA1578009775OtherMEDICAID QMB
VA1578009775OtherHUMANA MEDICARE
VA1578009775OtherANTHEM MEDIGAP