Individual
KATIE LYNN BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3745 HOLLAND RD STE 200, VIRGINIA BEACH, VA 23452-2866
(757) 395-1700
Mailing address
1009 S KENT ST, WINCHESTER, VA 22601-4571
(540) 497-1612
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110009105
VA
363A00000X
Physician Assistant
1180756
VA
Other
Enumeration date
01/26/2023
Last updated
03/20/2023
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