Healthcare Provider Details

I. General information

NPI: 1265349799
Provider Name (Legal Business Name): KAYLEE ATEHORTUA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

400 WATERSIDE DR APT 429
NORFOLK VA
23510-2120
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3000
  • Fax:
Mailing address:
  • Phone: 516-384-4795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202223844
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: