Healthcare Provider Details

I. General information

NPI: 1871141358
Provider Name (Legal Business Name): KATHLEEN OLESON PCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2019
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 DISCOVERY DR STE A
RICHMOND VA
23229-8605
US

IV. Provider business mailing address

7202 GLEN FOREST DR STE 200
RICHMOND VA
23226-3780
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-3000
  • Fax: 804-673-2731
Mailing address:
  • Phone: 804-673-2024
  • Fax: 804-200-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024177852
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: