Healthcare Provider Details

I. General information

NPI: 1285545632
Provider Name (Legal Business Name): INDIGO HARMONY HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 VIRGINIA AVE STE E
CLARKSVILLE VA
23927-9245
US

IV. Provider business mailing address

8401 MAYLAND DR STE A
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 434-788-9510
  • Fax:
Mailing address:
  • Phone: 434-788-9510
  • Fax:

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: JENNIFER CLARK
Title or Position: NURSE PRACTITIONER
Credential: FNP
Phone: 434-788-9510