Provider Demographics
NPI:1972327153
Name:PLUNKETT, KATIE MICHELLE (ACNPC-AG)
Entity type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:MICHELLE
Last Name:PLUNKETT
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:MISS
Other - First Name:KATIE
Other - Middle Name:MICHELLE
Other - Last Name:NOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16907 BROADMOOR RD
Mailing Address - Street 2:
Mailing Address - City:MOSELEY
Mailing Address - State:VA
Mailing Address - Zip Code:23120-2407
Mailing Address - Country:US
Mailing Address - Phone:804-433-0381
Mailing Address - Fax:
Practice Address - Street 1:16907 BROADMOOR RD
Practice Address - Street 2:
Practice Address - City:MOSELEY
Practice Address - State:VA
Practice Address - Zip Code:23120-2407
Practice Address - Country:US
Practice Address - Phone:804-433-0381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191781363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care