Healthcare Provider Details

I. General information

NPI: 1508577503
Provider Name (Legal Business Name): ABISOLA MORIAM CANADY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 LORI RD
CHESTERFIELD VA
23832-6758
US

IV. Provider business mailing address

9850 LORI RD
CHESTERFIELD VA
23832-6758
US

V. Phone/Fax

Practice location:
  • Phone: 804-353-3585
  • Fax:
Mailing address:
  • Phone: 917-558-7986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024185894
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185894
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: