MEDICARE: MRS. LAUREN ASHLEY KONTRA PA-C

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	363A00000X	Physician Assistant	0110-005647	VA

General Provider Information

NPI Number	:	1528500014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAUREN ASHLEY KONTRA PA-C

Provider Business Mailing Address
First Line	:	9759 HONEYBEE DR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2639
Country	:	US
Telephone Number	:	804-814-4403
Fax Number	:

Provider Business Practice Location Address
First Line	:	10200 THREE CHOPT RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-2083
Country	:	US
Telephone Number	:	804-288-3277
Fax Number	:

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

Provider Enumeration Date	:	11/15/2016
Last Update Date	:	11/20/2023

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