Provider Demographics
NPI:1801558283
Name:HARPER-PATTERSON, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:HARPER-PATTERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 CHESTNUT KNOB RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWAY
Mailing Address - State:VA
Mailing Address - Zip Code:24148-4773
Mailing Address - Country:US
Mailing Address - Phone:276-252-7194
Mailing Address - Fax:
Practice Address - Street 1:3600 CHESTNUT KNOB RD
Practice Address - Street 2:
Practice Address - City:RIDGEWAY
Practice Address - State:VA
Practice Address - Zip Code:24148-4773
Practice Address - Country:US
Practice Address - Phone:276-252-7194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11092610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA852435815Medicaid