Healthcare Provider Details

I. General information

NPI: 1922676907
Provider Name (Legal Business Name): CASSIE AHRENS PMHNP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/01/2022
Certification Date: 06/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BYRD AVE
RICHMOND VA
23230-3033
US

IV. Provider business mailing address

PO BOX 17102
RICHMOND VA
23226-7102
US

V. Phone/Fax

Practice location:
  • Phone: 804-592-6311
  • Fax:
Mailing address:
  • Phone: 804-415-4113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CASHEL AHRENS
Title or Position: LICENSED NURSE PRACTITIONER
Credential: PMHNP
Phone: 804-415-4113