Provider Demographics
NPI:1922468859
Name:CASE MANAGEMENT ASSOCIATES LLC
Entity Type:Organization
Organization Name:CASE MANAGEMENT ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KETTER
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:804-324-5051
Mailing Address - Street 1:700 S SYCAMORE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5802
Mailing Address - Country:US
Mailing Address - Phone:804-324-5051
Mailing Address - Fax:
Practice Address - Street 1:700 S SYCAMORE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5802
Practice Address - Country:US
Practice Address - Phone:804-324-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001146276364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty