Provider Demographics
NPI:1366193443
Name:COLE, KATHY LEE (FNP-C)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:LEE
Last Name:COLE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 CLAYPOOL HILL MALL RD STE 20
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-8200
Mailing Address - Country:US
Mailing Address - Phone:276-345-4688
Mailing Address - Fax:246-304-4150
Practice Address - Street 1:1051 CLAYPOOL HILL MALL RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-8203
Practice Address - Country:US
Practice Address - Phone:276-701-7389
Practice Address - Fax:276-345-4150
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183449363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366193443Medicaid