Provider Demographics
NPI:1609856798
Name:ADAMS, KATHRYN COSTELLO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:COSTELLO
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:LILLIAN
Other - Last Name:COSTELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:17567 WAYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22026-4513
Mailing Address - Country:US
Mailing Address - Phone:703-221-4776
Mailing Address - Fax:703-576-1414
Practice Address - Street 1:14450 SMOKETOWN RD
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-4712
Practice Address - Country:US
Practice Address - Phone:703-576-1419
Practice Address - Fax:703-576-1414
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001270363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical