Provider Demographics
NPI:1154394187
Name:WOTRING, KATHY S (CRNA)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:S
Last Name:WOTRING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 FOX DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22603-8613
Mailing Address - Country:US
Mailing Address - Phone:540-662-8336
Mailing Address - Fax:540-662-8593
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-8000
Practice Address - Fax:540-536-7780
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001100650367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1144248907OtherCIGNA
WV1144248907OtherCOMPNET
1144248907OtherHEALTHNET TRICARE
WV1144248907Medicaid
OH1154394187OtherPEIA WELLS FARGO
WV1144248907OtherBRICKSTREET
OHPENDINGMedicaid
WV1144248907OtherAETNA
WV1144248907OtherMOUNTAIN STATE BCBS
VA009559035Medicaid
WV1154394187OtherSELECT NET
WVPENDINGOther4MOST
WV1144248907OtherHUMANA
WVPENDINGOtherOHIO BWC
OHPENDINGMedicaid
WVPENDINGOther4MOST