Healthcare Provider Details

I. General information

NPI: 1972774552
Provider Name (Legal Business Name): ROBERT TIMOTHY O'BYRNE APMH-NP/CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 RAINTREE RD STE A
CHESAPEAKE VA
23321-3749
US

IV. Provider business mailing address

4020 RAINTREE RD STE A
CHESAPEAKE VA
23321-3749
US

V. Phone/Fax

Practice location:
  • Phone: 757-606-1377
  • Fax:
Mailing address:
  • Phone: 757-621-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number59180
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024166755
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: