Provider Demographics
NPI:1588787485
Name:CHESTER, KATINA DENICE
Entity type:Individual
Prefix:MS
First Name:KATINA
Middle Name:DENICE
Last Name:CHESTER
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 1:100 S KELLAM RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3827
Mailing Address - Country:US
Mailing Address - Phone:757-389-2562
Mailing Address - Fax:
Practice Address - Street 1:100 S KELLAM RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3827
Practice Address - Country:US
Practice Address - Phone:757-389-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA62140523172A00000X, 343900000X
VA342000000X
KS0057558-004343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No342000000XTransportation ServicesTransportation Network Company
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200421000AMedicaid