Healthcare Provider Details

I. General information

NPI: 1639658065
Provider Name (Legal Business Name): KASEY GAULDEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2018
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 STONY POINT PKWY
RICHMOND VA
23235-1900
US

IV. Provider business mailing address

PO BOX 91734
RICHMOND VA
23291-1734
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-8945
  • Fax: 804-560-7342
Mailing address:
  • Phone: 804-358-6100
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176452
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: