Provider Demographics
NPI:1215690623
Name:ROOD, KATIE JO
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:JO
Last Name:ROOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 PUMP RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-1115
Mailing Address - Country:US
Mailing Address - Phone:804-404-6270
Mailing Address - Fax:
Practice Address - Street 1:3540 PUMP RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23233-1115
Practice Address - Country:US
Practice Address - Phone:804-404-6270
Practice Address - Fax:804-294-2775
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNURR37093163W00000X
IN28200849A163W00000X
AK186381363LF0000X
IN71014001A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse