Healthcare Provider Details

I. General information

NPI: 1770397465
Provider Name (Legal Business Name): KATHRYN ANN O'GRADY TABOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 KEMPSVILLE RD STE 205
NORFOLK VA
23502-3957
US

IV. Provider business mailing address

880 KEMPSVILLE RD STE 205
NORFOLK VA
23502-3957
US

V. Phone/Fax

Practice location:
  • Phone: 757-451-0929
  • Fax:
Mailing address:
  • Phone: 757-451-0929
  • Fax: 757-904-3694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024192480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: