Healthcare Provider Details

I. General information

NPI: 1902767247
Provider Name (Legal Business Name): MS. ALVITA NICHOLE BARLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18801 HARRISONS RD
JETERSVILLE VA
23083-2228
US

IV. Provider business mailing address

18801 HARRISONS RD
JETERSVILLE VA
23083-2228
US

V. Phone/Fax

Practice location:
  • Phone: 804-317-0393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197904
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: