Provider Demographics
NPI:1790802528
Name:ST.GERMAIN, KATHLEEN MARIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:ST.GERMAIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8611 KENTFORD DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3247
Mailing Address - Country:US
Mailing Address - Phone:703-644-6788
Mailing Address - Fax:
Practice Address - Street 1:1850 TOWN CENTER PARKWAY
Practice Address - Street 2:FAMILY HEALTH CENTER
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-834-7584
Practice Address - Fax:703-318-8427
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840713363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical