Healthcare Provider Details

I. General information

NPI: 1447109269
Provider Name (Legal Business Name): WILLIAM LOGAN KANTSIOS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 FOOTHILLS RD
CALLAWAY VA
24067-5453
US

IV. Provider business mailing address

1959 FOOTHILLS RD
CALLAWAY VA
24067-5453
US

V. Phone/Fax

Practice location:
  • Phone: 540-921-7813
  • Fax:
Mailing address:
  • Phone: 540-921-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198175
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: