Healthcare Provider Details

I. General information

NPI: 1669773297
Provider Name (Legal Business Name): CAITLIN KUFAHL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2010
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13347 WARWICK BLVD
NEWPORT NEWS VA
23602-5601
US

IV. Provider business mailing address

860 OMNI BLVD STE 100
NEWPORT NEWS VA
23606-4434
US

V. Phone/Fax

Practice location:
  • Phone: 757-877-0214
  • Fax: 757-875-0524
Mailing address:
  • Phone: 757-232-8769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: