Healthcare Provider Details

I. General information

NPI: 1942702253
Provider Name (Legal Business Name): KASEY V CAMBERO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASEY V CRAWFORD

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 04/03/2024
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WESTERRE PKWY STE 300
RICHMOND VA
23233-1339
US

IV. Provider business mailing address

11600 SPRINGHOUSE PL
RESTON VA
20194-1163
US

V. Phone/Fax

Practice location:
  • Phone: 443-383-9300
  • Fax: 855-866-8710
Mailing address:
  • Phone: 443-383-9300
  • Fax: 855-866-8710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR186205
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPN.0994851-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024184842
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: