Healthcare Provider Details

I. General information

NPI: 1003329111
Provider Name (Legal Business Name): KATHY NIPPERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY JEAN WILSON

II. Dates (important events)

Enumeration Date: 11/10/2017
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 SEMINOLE LN STE 200
CHARLOTTESVILLE VA
22901-8303
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-980-6161
  • Fax: 434-972-4283
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024187761
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187761
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0030119
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number22607
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code163WF0300X
TaxonomyFlight Registered Nurse
License Number22607
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: