Provider Demographics
NPI:1891502936
Name:IVORY, CATHY ANN MATEO (FNP)
Entity type:Individual
Prefix:
First Name:CATHY ANN
Middle Name:MATEO
Last Name:IVORY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CATHY ANN
Other - Middle Name:ALCANTARA
Other - Last Name:MATEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:6078 FRANCONIA RD STE A
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-4425
Mailing Address - Country:US
Mailing Address - Phone:703-921-0256
Mailing Address - Fax:703-921-0257
Practice Address - Street 1:6078 FRANCONIA RD STE A
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-4425
Practice Address - Country:US
Practice Address - Phone:703-921-0256
Practice Address - Fax:703-921-0257
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024192071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily