Healthcare Provider Details

I. General information

NPI: 1205069515
Provider Name (Legal Business Name): LE ROY J HALSTEAD RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 12/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 KELSEY BAY CT
CHESAPEAKE VA
23323-5346
US

IV. Provider business mailing address

2003 KELSEY BAY CT
CHESAPEAKE VA
23323-5346
US

V. Phone/Fax

Practice location:
  • Phone: 757-376-6882
  • Fax: 757-558-3633
Mailing address:
  • Phone: 757-376-6882
  • Fax: 757-558-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001156312
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: