Healthcare Provider Details

I. General information

NPI: 1053918847
Provider Name (Legal Business Name): KATHERINE SUSAN DENNIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 BELMONT AVE STE 201
SALISBURY MD
21804-4593
US

IV. Provider business mailing address

6470 HOLLY DR
CHINCOTEAGUE VA
23336-3813
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-6833
  • Fax:
Mailing address:
  • Phone: 757-710-3574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0001232312
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001232312
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: