Healthcare Provider Details

I. General information

NPI: 1457279549
Provider Name (Legal Business Name): KATYSSON EDUARDO FONSECA DE CARVALHO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 NINE MILE ROAD SUITE 220
RICHMOND VA
23223
US

IV. Provider business mailing address

4517 PARK AVE
RICHMOND VA
23221-1128
US

V. Phone/Fax

Practice location:
  • Phone: 804-266-2222
  • Fax:
Mailing address:
  • Phone: 804-651-5196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0001249738
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0001249738
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: