Provider Demographics
NPI:1972553212
Name:SCARBALIS, KATHLEEN ANNE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:SCARBALIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:111 CLUB HIGHLAND STE 200
Mailing Address - Street 2:
Mailing Address - City:NELLYSFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22958-2349
Mailing Address - Country:US
Mailing Address - Phone:719-201-1480
Mailing Address - Fax:
Practice Address - Street 1:111 CLUB HIGHLAND STE 200
Practice Address - Street 2:
Practice Address - City:NELLYSFORD
Practice Address - State:VA
Practice Address - Zip Code:22958-2349
Practice Address - Country:US
Practice Address - Phone:719-201-1480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840338363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical