Healthcare Provider Details

I. General information

NPI: 1609240852
Provider Name (Legal Business Name): ANGELA CARSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2015
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 WESTERRE PKWY STE 300
RICHMOND VA
23233-1339
US

IV. Provider business mailing address

3900 WESTERRE PKWY STE 300
RICHMOND VA
23233-1339
US

V. Phone/Fax

Practice location:
  • Phone: 571-579-8640
  • Fax:
Mailing address:
  • Phone: 571-579-8640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001233254
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024180498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: