Provider Demographics
NPI:1659930758
Name:OKEEFE, KATHRYN (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2207 JEFFERSON PARK AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-3017
Mailing Address - Country:US
Mailing Address - Phone:443-802-5577
Mailing Address - Fax:
Practice Address - Street 1:2207 JEFFERSON PARK AVE APT B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVLE
Practice Address - State:VA
Practice Address - Zip Code:22903-3017
Practice Address - Country:US
Practice Address - Phone:443-802-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995634-NP363LA2100X, 363LF0000X, 363LG0600X
COC-APN.0001501-C-NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology