Provider Demographics
NPI:1356992853
Name:KPNP
Entity type:Organization
Organization Name:KPNP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:804-617-0687
Mailing Address - Street 1:8353 DUSTY LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2406
Mailing Address - Country:US
Mailing Address - Phone:804-617-0687
Mailing Address - Fax:804-282-9135
Practice Address - Street 1:8353 DUSTY LN
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2406
Practice Address - Country:US
Practice Address - Phone:804-617-0687
Practice Address - Fax:804-282-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty