Basic Information
| Provider Information | |||||||||
| NPI: | 1477656023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | KATHI | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 FRONT ST W | ||||||||
| Address2: | |||||||||
| City: | COEBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242303607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763952389 | ||||||||
| FaxNumber: | 2763956634 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 FRONT ST W | ||||||||
| Address2: | |||||||||
| City: | COEBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242303607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763952389 | ||||||||
| FaxNumber: | 2763956634 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 02/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024164956 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 7100130340 | 05 | KY | MEDICAID | P00687791 | 01 | RR MEDICARE | OTHER | 1477656023 | 05 | VA | MEDICAID |