Healthcare Provider Details

I. General information

NPI: 1720616295
Provider Name (Legal Business Name): JOURNEY HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 01/04/2026
Certification Date: 01/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CONCOURSE BLVD STE 150
GLEN ALLEN VA
23059-5751
US

IV. Provider business mailing address

100 CONCOURSE BLVD STE 150
GLEN ALLEN VA
23059-5751
US

V. Phone/Fax

Practice location:
  • Phone: 804-416-6673
  • Fax: 804-886-9046
Mailing address:
  • Phone: 804-416-6673
  • Fax: 804-886-9046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA TUCKER ANDERSON
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 804-416-6673