Provider Demographics
NPI:1962682534
Name:GERARGE, KATIE JANE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:JANE
Last Name:GERARGE
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 1:3315 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3319
Mailing Address - Country:US
Mailing Address - Phone:757-399-0759
Mailing Address - Fax:757-397-8951
Practice Address - Street 1:3315 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3319
Practice Address - Country:US
Practice Address - Phone:757-399-0759
Practice Address - Fax:757-397-8951
Is Sole Proprietor?:No
Enumeration Date:2007-11-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002095363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMS1280370OtherDEA #
VAVAA104193Medicare PIN