Provider Demographics
NPI:1790742385
Name:PAUL, KATHERINE SUE (NP)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:SUE
Last Name:PAUL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:667 KINGSBOROUGH SQ STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4999
Mailing Address - Country:US
Mailing Address - Phone:757-312-3085
Mailing Address - Fax:757-312-6550
Practice Address - Street 1:800 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4999
Practice Address - Country:US
Practice Address - Phone:757-312-3085
Practice Address - Fax:757-923-6237
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164242363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA500030057OtherRAILROAD MEDICARE
NC7003974Medicaid
VA7789301Medicaid
VA500000851Medicare PIN
VA7789301Medicaid