Healthcare Provider Details

I. General information

NPI: 1629618871
Provider Name (Legal Business Name): KAYLEE L ZAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 CLEARFIELD AVE STE 215
VIRGINIA BEACH VA
23462-1893
US

IV. Provider business mailing address

PO BOX 639295 DEPT 93394
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 757-853-1380
  • Fax:
Mailing address:
  • Phone: 248-434-6169
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024178699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: