Provider Demographics
NPI:1639154099
Name:ZIMMERMAN, KATIE CRAIN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:CRAIN
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 WOODBURN RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1297
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 WOODBURN RD STE 107
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1297
Practice Address - Country:US
Practice Address - Phone:703-876-0437
Practice Address - Fax:703-876-0722
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03643164W00000X
VA0024168384363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1431567Medicaid
LA4B4567549Medicare PIN
LA1431567Medicaid