Healthcare Provider Details

I. General information

NPI: 1649716184
Provider Name (Legal Business Name): CHRISTY D. KOGER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 BETHEL CHURCH RD
NEW CASTLE VA
24127-7852
US

IV. Provider business mailing address

1044 BETHEL CHURCH RD
NEW CASTLE VA
24127-7852
US

V. Phone/Fax

Practice location:
  • Phone: 540-864-5500
  • Fax: 540-864-5505
Mailing address:
  • Phone: 540-864-5500
  • Fax: 540-864-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001213291
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number1649716184
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: