MEDICARE: KAREN KAECHELE COSTANTINO

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	163W00000X	Registered Nurse	0001296730	VA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024195467	VA

General Provider Information

NPI Number	:	1205785003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN KAECHELE COSTANTINO

Provider Business Mailing Address
First Line	:	35 EGRET POINT DR
Second Line	:
City	:	LOCUST HILL
State	:	VA
Zip	:	23092-9710
Country	:	US
Telephone Number	:	804-973-3216
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 EGRET POINT DR
Second Line	:
City	:	LOCUST HILL
State	:	VA
Zip	:	23092-9710
Country	:	US
Telephone Number	:	703-973-3216
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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