Healthcare Provider Details

I. General information

NPI: 1578084091
Provider Name (Legal Business Name): KATELYNE M HALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS KATELYNE M COTE

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date: 09/25/2019
Reactivation Date: 10/23/2019

III. Provider practice location address

661 INDEPENDENCE PKWY STE 120
CHESAPEAKE VA
23320-5114
US

IV. Provider business mailing address

ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
GERMANTOWN TN
38183-1468
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-0798
  • Fax: 757-547-0145
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: