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Individual

MRS. KATHRYN LEE LAVIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
AGPCNP-BC

Contact information

Practice address
7001 FOREST AVE, SUITE 100, RICHMOND, VA 23230-1726
(804) 893-8627
(804) 673-5497
Mailing address
7001 FOREST AVE, SUITE 100, RICHMOND, VA 23230-1726
(804) 893-8627
(804) 673-5497

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001155115
VA
363LA2200X
Adult Health Nurse Practitioner
Primary
0024171076
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C06778
GROUP PTAN
VA
Enumeration date
08/16/2013
Last updated
05/15/2014
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