Healthcare Provider Details

I. General information

NPI: 1235706250
Provider Name (Legal Business Name): RYAN ERNEST PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 COX RD STE 205
GLEN ALLEN VA
23060-6803
US

IV. Provider business mailing address

4801 COX RD STE 205
GLEN ALLEN VA
23060-6803
US

V. Phone/Fax

Practice location:
  • Phone: 804-796-0790
  • Fax: 804-796-0799
Mailing address:
  • Phone: 804-796-0790
  • Fax: 804-796-0799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024182462
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0024182462
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: