Healthcare Provider Details

I. General information

NPI: 1841742384
Provider Name (Legal Business Name): KASHA DENNA FADOUL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASHA DENNA MCCOY FNP-BC

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 HALL AVE
SUFFOLK VA
23434-4657
US

IV. Provider business mailing address

135 HALL AVE
SUFFOLK VA
23434-4657
US

V. Phone/Fax

Practice location:
  • Phone: 757-514-4700
  • Fax:
Mailing address:
  • Phone: 757-514-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001276705
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number81858
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN81858-FNP-BC
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024175624
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: