Provider Demographics
NPI:1942614235
Name:LOOSE, KATHERINE STEPHENSON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:STEPHENSON
Last Name:LOOSE
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:5818 HARBOUR VIEW BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3315
Mailing Address - Country:US
Mailing Address - Phone:757-673-6000
Mailing Address - Fax:757-673-6007
Practice Address - Street 1:5818 HARBOUR VIEW BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-673-6000
Practice Address - Fax:757-673-6007
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110004592363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant