Katie Lynn Bacon, PA-C
Physician Assistant in Virginia Beach, VA. Individual provider (NPI-1).
NPI number1952017519
StatusActive
Last updated in NPPESMar 20, 2023
Details
- NPI
- 1952017519
- Entity type
- Individual (NPI-1)
- Name
- Katie Lynn Bacon
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jan 26, 2023
- Certification date
- Mar 20, 2023
- Last updated
- Mar 20, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 0110009105 | VA | Yes |
| 363A00000X | Physician Assistant | 1180756 | VA |
Practice location
3745 Holland Rd Ste 200Virginia Beach, VA 23452-2866
Phone 757-395-1700
Mailing address
1009 S Kent StWinchester, VA 22601-4571
Phone 540-497-1612
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All 274 Physician Assistant providers in Virginia Beach · All 12,483 providers in Virginia Beach
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