Provider Demographics
NPI:1124451893
Name:LAVIS, KATHRYN LEE (AGPCNP-BC)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:LEE
Last Name:LAVIS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1726
Mailing Address - Country:US
Mailing Address - Phone:804-893-8627
Mailing Address - Fax:804-673-5497
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-893-8627
Practice Address - Fax:804-673-5497
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001155115163W00000X
VA0024171076363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN