Healthcare Provider Details

I. General information

NPI: 1972411155
Provider Name (Legal Business Name): KATE FOWLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 UNIVERSITY DR
VIRGINIA BEACH VA
23453-8083
US

IV. Provider business mailing address

4704 W GRACE ST
RICHMOND VA
23230-3722
US

V. Phone/Fax

Practice location:
  • Phone: 757-683-4297
  • Fax: 757-683-5253
Mailing address:
  • Phone: 757-754-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001296153
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: