Healthcare Provider Details

I. General information

NPI: 1558841528
Provider Name (Legal Business Name): MRS. KATHRYN CARTER ESWORTHY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2018
Last Update Date: 03/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

711 MCCAULIFF DR
NORTH CHESTERFIELD VA
23236-4820
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-2011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024177238
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001244786
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: