Provider Demographics
NPI:1629406129
Name:ANDERSON, KATHRYN LEIGH (FNP, RN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LEIGH
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 SAMPSON RD
Mailing Address - Street 2:
Mailing Address - City:DAHLGREN
Mailing Address - State:VA
Mailing Address - Zip Code:22448-3028
Mailing Address - Country:US
Mailing Address - Phone:580-618-2992
Mailing Address - Fax:
Practice Address - Street 1:9000 STAPLES MILL RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2021
Practice Address - Country:US
Practice Address - Phone:804-977-9526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-18
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019948363LF0000X
VA0024178930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily