Provider Demographics
NPI:1578541850
Name:GRILLO, KATHY HANCOCK (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:HANCOCK
Last Name:GRILLO
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:525 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-1119
Mailing Address - Country:US
Mailing Address - Phone:757-488-0563
Mailing Address - Fax:757-673-4362
Practice Address - Street 1:3706WINCHESTER DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-4332
Practice Address - Country:US
Practice Address - Phone:757-393-4124
Practice Address - Fax:757-393-4991
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024053012363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA562081Medicare UPIN
VA500000376Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER