MEDICARE: CASSANDRA LYNN BOZARD MSN,APRN,PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024192158	VA

General Provider Information

NPI Number	:	1952115933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA LYNN BOZARD MSN,APRN,PMHNP-BC

Provider Business Mailing Address
First Line	:	1717 MILL LANDING RD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23457-1442
Country	:	US
Telephone Number	:	757-503-5122
Fax Number	:	757-207-9195

Provider Business Practice Location Address
First Line	:	555 BELAIRE AVE STE 210
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-4783
Country	:	US
Telephone Number	:	757-260-9273
Fax Number	:	757-207-9195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2025
Last Update Date	:	12/03/2025

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