Healthcare Provider Details

I. General information

NPI: 1437955226
Provider Name (Legal Business Name): PAULA G. GRAVITT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 BELAIRE AVE
CHESAPEAKE VA
23320-4783
US

IV. Provider business mailing address

1600 WHIPPOORWILL TRCE
CHESAPEAKE VA
23322-1275
US

V. Phone/Fax

Practice location:
  • Phone: 757-828-5659
  • Fax: 757-992-8583
Mailing address:
  • Phone: 804-921-5580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. PAULA GAYLE GRAVITT
Title or Position: OWNER/PMHNP
Credential: PMHNP-BC
Phone: 757-828-5659