Provider Demographics
NPI:1255889168
Name:GEORGE, KATHARINE L (AG-ACNP)
Entity type:Individual
Prefix:
First Name:KATHARINE
Middle Name:L
Last Name:GEORGE
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:L
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AG-ACNP
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 LEE STREET
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-3363
Practice Address - Country:US
Practice Address - Phone:434-924-5348
Practice Address - Fax:434-924-8335
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174002363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care