Healthcare Provider Details

I. General information

NPI: 1871433052
Provider Name (Legal Business Name): KATIE CROSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7474 LIMESTONE DR
GAINESVILLE VA
20155-4007
US

IV. Provider business mailing address

126 PITTMAN CT
STEPHENS CITY VA
22655-2891
US

V. Phone/Fax

Practice location:
  • Phone: 703-721-7218
  • Fax:
Mailing address:
  • Phone: 920-609-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001304032
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: