Healthcare Provider Details

I. General information

NPI: 1851046031
Provider Name (Legal Business Name): VITAL HEALTH & INTEGRATIVE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2022
Last Update Date: 02/16/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 TOWN AND COUNTRY DRIVE STE 119 #153
FREDERICKBURG VA
22405
US

IV. Provider business mailing address

43 TOWN AND COUNTRY DRIVE STE 119 #153
FREDERICKBURG VA
22405
US

V. Phone/Fax

Practice location:
  • Phone: 571-505-1744
  • Fax:
Mailing address:
  • Phone: 571-505-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMINATA KAMARA
Title or Position: OWNER
Credential: NP
Phone: 571-505-1744