Healthcare Provider Details

I. General information

NPI: 1669886578
Provider Name (Legal Business Name): COURTNEY M. SUBUDHI DNP, CNM, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 BROAD STREET RD STE 1012
MANAKIN SABOT VA
23103-2213
US

IV. Provider business mailing address

42 BROAD STREET RD STE 1012
MANAKIN SABOT VA
23103-2213
US

V. Phone/Fax

Practice location:
  • Phone: 804-376-5319
  • Fax: 804-203-0806
Mailing address:
  • Phone: 804-376-5319
  • Fax: 804-203-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5021909
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberTPAN3132
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173593
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024173593
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTPAN3132
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021909
License Number StateNC
# 7
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024173593
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: