1154305795 NPI number — MRS. KATHRYN A POND FNP

Table of content: MRS. KATHRYN A POND FNP (NPI 1154305795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154305795 NPI number — MRS. KATHRYN A POND FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POND
Provider First Name:
KATHRYN
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154305795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5818 HARBOUR VIEW BLVD
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
SUFFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23435-3315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-483-6100
Provider Business Mailing Address Fax Number:
757-673-5950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5818 HARBOUR VIEW BLVD
Provider Second Line Business Practice Location Address:
STE 240
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23435-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-483-6100
Provider Business Practice Location Address Fax Number:
757-673-5950
Provider Enumeration Date:
12/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024113609 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C05825 . This is a "MEDICARE GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 42486N . This is a "SENTARA OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: C13214 . This is a "MEDICARE RR GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 541870984006 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".




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