Healthcare Provider Details

I. General information

NPI: 1134939754
Provider Name (Legal Business Name): KATHRYN L CANARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 COLISEUM DR
HAMPTON VA
23666-5963
US

IV. Provider business mailing address

825 FAIRFAX AVE
NORFOLK VA
23507-1914
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011093
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: