Healthcare Provider Details

I. General information

NPI: 1699700633
Provider Name (Legal Business Name): KATHY SHEA APN, CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY PEIFER APN, CFNP

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MCLAWS CIR STE 105
WILLIAMSBURG VA
23185-5674
US

IV. Provider business mailing address

263 MCLAWS CIR STE 105
WILLIAMSBURG VA
23185-5674
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-5600
  • Fax: 757-564-0557
Mailing address:
  • Phone: 757-941-5600
  • Fax: 757-564-0557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209002514
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171252
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: