Healthcare Provider Details

I. General information

NPI: 1619620309
Provider Name (Legal Business Name): KATELYN ANN SEAY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 12/11/2022
Certification Date: 02/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4035 ELECTRIC RD STE A
ROANOKE VA
24018-8449
US

IV. Provider business mailing address

46 WESLEY RD
DALEVILLE VA
24083-3082
US

V. Phone/Fax

Practice location:
  • Phone: 540-772-8670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number0001263790
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024183801
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: