Healthcare Provider Details

I. General information

NPI: 1003757071
Provider Name (Legal Business Name): KATHRYN KEMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 OPITZ BLVD
WOODBRIDGE VA
22191-3311
US

IV. Provider business mailing address

2300 OPITZ BLVD
WOODBRIDGE VA
22191-3311
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number0024194561
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: