Healthcare Provider Details

I. General information

NPI: 1457758393
Provider Name (Legal Business Name): BLUE SKY PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2014
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MONTICELLO AVE STE 1844
NORFOLK VA
23510-2571
US

IV. Provider business mailing address

440 MONTICELLO AVE STE 1844
NORFOLK VA
23510-2571
US

V. Phone/Fax

Practice location:
  • Phone: 757-773-3456
  • Fax: 757-282-5748
Mailing address:
  • Phone: 757-773-3456
  • Fax: 757-282-5748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168880
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KAREN DIANE BEATTY
Title or Position: MANAGER/PROVIDER
Credential: MSN, FNP-C
Phone: 757-773-3456