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General NPI Number Information
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NPI Number | 1124904727
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Entity Type | Organization
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Legal Business Name | KAPTIVATIVE KONSULTANTS PLLC
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Dates
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Enumeration Date | 08/12/2025
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 184 BUSINESS PARK DR STE 208
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6587
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Country | US
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Telephone | 757-644-9847
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Fax |
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Provider Business Mailing Address
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Address Line | 184 BUSINESS PARK DR STE 208
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-6587
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Country | US
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Telephone | 757-644-9847
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | SHERRY RITA JOHNSON
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Credential | FNP
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Telephone | 757-644-9847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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