Provider Demographics
NPI:1487304762
Name:CHASTEEN, KATHLEEN ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELAINE
Last Name:CHASTEEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20116 ASHBROOK PL STE 150
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5087
Mailing Address - Country:US
Mailing Address - Phone:703-385-5203
Mailing Address - Fax:
Practice Address - Street 1:19500 SANDRIDGE WAY, SUITE 420
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176
Practice Address - Country:US
Practice Address - Phone:571-375-8601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487304762Medicaid
VA30017448960002Medicaid