Healthcare Provider Details

I. General information

NPI: 1700798287
Provider Name (Legal Business Name): KATRINA CHENOWETH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DR
HAMPTON VA
23666-5957
US

IV. Provider business mailing address

5 SEAY CT
FREDERICKSBURG VA
22405-1741
US

V. Phone/Fax

Practice location:
  • Phone: 757-736-1000
  • Fax:
Mailing address:
  • Phone: 540-907-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012383
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: