Kathryn Rose Eagle, LDO
Individual provider Active NPI Contractor · Glasgow, VA
NPI 1235315664 · NPPES record last updated Jan 16, 2008
Key facts
- NPI
- 1235315664
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 1101003356 (VA)
- Practice address
- 166 Tinkerville Rd
Glasgow, VA 24555-2962 - Phone
- (540) 291-3373
- Fax
- (540) 291-3373
- NPI assigned
- Jan 16, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1101003356 | VA | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 1101003356 | VA | Yes |
Addresses
Primary practice location
166 Tinkerville Rd
Glasgow, VA 24555-2962
Mailing address
166 Tinkerville Rd
Glasgow, VA 24555-2962
Phone (540) 291-3373
Other providers in Glasgow, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.