Provider Demographics
NPI:1386895860
Name:GORHAM, KATHLEEN ANN (CRNP-A)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANN
Last Name:GORHAM
Suffix:
Gender:F
Credentials:CRNP-A
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:GORHAM-FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:450 GARRISONVILLE RD
Mailing Address - Street 2:STE 109
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1532
Mailing Address - Country:US
Mailing Address - Phone:703-522-2727
Mailing Address - Fax:703-542-3753
Practice Address - Street 1:450 GARRISONVILLE RD STE 109
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1532
Practice Address - Country:US
Practice Address - Phone:703-522-2727
Practice Address - Fax:703-542-3753
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health