Healthcare Provider Details

I. General information

NPI: 1417500810
Provider Name (Legal Business Name): KATHRYN HUMPHREY MYERS NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

4016 LAKE ASHBY CT
WARRENTON VA
20187-5868
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-1400
  • Fax:
Mailing address:
  • Phone: 540-818-6455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number0024177929
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: