Provider Demographics
NPI:1770607335
Name:EWING, KASAUNDRA N (NP)
Entity type:Individual
Prefix:
First Name:KASAUNDRA
Middle Name:N
Last Name:EWING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 S NEWTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-5718
Mailing Address - Country:US
Mailing Address - Phone:757-892-5520
Mailing Address - Fax:757-892-5521
Practice Address - Street 1:249 S NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-5718
Practice Address - Country:US
Practice Address - Phone:757-892-5520
Practice Address - Fax:757-892-5521
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner