MEDICARE: MRS. KATHRYN A POND FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024113609	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C05825	OTHER		MEDICARE GROUP
3	C13214	OTHER		MEDICARE RR GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	42486N	OTHER		SENTARA OPTIMA
4	541870984006	OTHER		CHAMPUS

General Provider Information

NPI Number	:	1154305795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHRYN A POND FNP

Provider Business Mailing Address
First Line	:	5818 HARBOUR VIEW BLVD
Second Line	:	STE 240
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3315
Country	:	US
Telephone Number	:	757-483-6100
Fax Number	:	757-673-5950

Provider Business Practice Location Address
First Line	:	5818 HARBOUR VIEW BLVD
Second Line	:	STE 240
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3315
Country	:	US
Telephone Number	:	757-483-6100
Fax Number	:	757-673-5950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/08/2007

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Directions to “ MRS. KATHRYN A POND FNP” Practice Location

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