Provider Demographics
NPI:1699227603
Name:MENDOZA, KATHLEEN U (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:U
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:337 MCLAWS CIR STE 3
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-6334
Mailing Address - Country:US
Mailing Address - Phone:757-345-2287
Mailing Address - Fax:757-345-2553
Practice Address - Street 1:337 MCLAWS CIR STE 3
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-6334
Practice Address - Country:US
Practice Address - Phone:757-345-2287
Practice Address - Fax:757-345-2553
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024174083363LP0808X, 363LP0808X, 363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health