Healthcare Provider Details

I. General information

NPI: 1275795676
Provider Name (Legal Business Name): KAREN MICHELLE CAPSHAW FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 IRON BRIDGE RD STE 117
CHESTER VA
23831-1467
US

IV. Provider business mailing address

PO BOX 639993
CINCINNATI OH
45263-9993
US

V. Phone/Fax

Practice location:
  • Phone: 804-717-5300
  • Fax: 804-748-7269
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: