Healthcare Provider Details

I. General information

NPI: 1346946779
Provider Name (Legal Business Name): KAITLIN SHEA ROADCAP FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 S MEDICAL PARK DR
FISHERSVILLE VA
22939-2333
US

IV. Provider business mailing address

505 THOROFARE RD
CRIMORA VA
24431-2412
US

V. Phone/Fax

Practice location:
  • Phone: 540-886-2956
  • Fax:
Mailing address:
  • Phone: 540-241-9938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024186441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: