Provider Demographics
NPI:1699700633
Name:SHEA, KATHY (APN, CFNP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:APN, CFNP
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:PEIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN, CFNP
Mailing Address - Street 1:263 MCLAWS CIR STE 105
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5674
Mailing Address - Country:US
Mailing Address - Phone:757-941-5600
Mailing Address - Fax:757-564-0557
Practice Address - Street 1:263 MCLAWS CIR STE 105
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5674
Practice Address - Country:US
Practice Address - Phone:757-941-5600
Practice Address - Fax:757-564-0557
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002514363L00000X
VA0024171252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner