Healthcare Provider Details

I. General information

NPI: 1518167139
Provider Name (Legal Business Name): ARDEN AYLESWORTH JR. GNP, PMHNP, ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 04/27/2025
Certification Date: 04/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 CEDARFIELD PKWY
RICHMOND VA
23233-1936
US

IV. Provider business mailing address

PO BOX 2516
MIDLOTHIAN VA
23113-8516
US

V. Phone/Fax

Practice location:
  • Phone: 804-464-8412
  • Fax: 804-372-9914
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024167444
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024167444
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024167444
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024167444
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: