Healthcare Provider Details

I. General information

NPI: 1588182315
Provider Name (Legal Business Name): AMY CHAPPELL PARKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 08/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST STE 3
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

20 W BANK ST STE 3
PETERSBURG VA
23803-3279
US

V. Phone/Fax

Practice location:
  • Phone: 804-722-4299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001155656
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: