Healthcare Provider Details

I. General information

NPI: 1184625030
Provider Name (Legal Business Name): KAREN REYNOLDS BRAYBOY MSN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 JOHN PAUL JONES CIR STE 275
PORTSMOUTH VA
23708-2197
US

IV. Provider business mailing address

2224 DULWICH PL
VIRGINIA BEACH VA
23456-7758
US

V. Phone/Fax

Practice location:
  • Phone: 757-953-4300
  • Fax: 757-953-9887
Mailing address:
  • Phone: 757-314-7236
  • Fax: 757-314-7228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024090250
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: