Healthcare Provider Details

I. General information

NPI: 1144870809
Provider Name (Legal Business Name): SPECIALTY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2019
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S MAIN ST
BLACKSTONE VA
23824-2644
US

IV. Provider business mailing address

PO BOX 4595
MIDLOTHIAN VA
23112-0010
US

V. Phone/Fax

Practice location:
  • Phone: 804-426-2742
  • Fax:
Mailing address:
  • Phone: 804-426-2742
  • Fax: 804-282-9135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KRISTLE CHAMBERS
Title or Position: NP/OWNER
Credential: NP
Phone: 804-426-2742