Healthcare Provider Details

I. General information

NPI: 1548128564
Provider Name (Legal Business Name): KATHERINE OLGA RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 01/10/2026
Certification Date: 01/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 NORTH SECTOR CT SUITE 200
WINCHESTER VA
22601
US

IV. Provider business mailing address

1775 NORTH SECTOR CT SUITE 200
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 540-542-6208
  • Fax:
Mailing address:
  • Phone: 540-542-6208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: