Provider Demographics
NPI:1841742384
Name:FADOUL, KASHA DENNA (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:KASHA
Middle Name:DENNA
Last Name:FADOUL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:KASHA
Other - Middle Name:DENNA
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:135 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4657
Mailing Address - Country:US
Mailing Address - Phone:757-514-4700
Mailing Address - Fax:
Practice Address - Street 1:135 HALL AVE
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4657
Practice Address - Country:US
Practice Address - Phone:757-514-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-01
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001276705163W00000X
WV81858163W00000X
WVAPRN81858-FNP-BC363LF0000X
VA0024175624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily