Healthcare Provider Details

I. General information

NPI: 1225049034
Provider Name (Legal Business Name): KATHRYN ANN POLLON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 PARKEAST CIR
CHANTILLY VA
20151-2295
US

IV. Provider business mailing address

2705 CLARKES LANDING DR
OAKTON VA
22124-1119
US

V. Phone/Fax

Practice location:
  • Phone: 703-968-4030
  • Fax: 703-263-1724
Mailing address:
  • Phone: 703-620-2405
  • Fax: 703-620-0523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001042873
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: