Healthcare Provider Details

I. General information

NPI: 1588484828
Provider Name (Legal Business Name): KATHLEEN GOOLSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH VA
23464-4122
US

IV. Provider business mailing address

5320 PROVIDENCE RD STE 301
VIRGINIA BEACH VA
23464-4122
US

V. Phone/Fax

Practice location:
  • Phone: 757-413-7600
  • Fax: 757-413-7601
Mailing address:
  • Phone: 757-413-7600
  • Fax: 757-413-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198055
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: