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General NPI Number Information
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NPI Number | 1922660760
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Entity Type | Individual
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Provider Name | KATHERINE NETTLES MILLOTT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 1970 ROANOKE BLVD
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City | SALEM
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State | VA
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Zip | 24153-6404
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Country | US
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Telephone | 540-982-2463
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Fax |
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Provider Business Mailing Address
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Address Line | 4521 LAURELWOOD DR
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City | ROANOKE
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State | VA
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Zip | 24018-1711
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Country | US
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Telephone | 614-323-5494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024177735
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License Number State | VA
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