Healthcare Provider Details

I. General information

NPI: 1073432324
Provider Name (Legal Business Name): EBONIE KANDICE ALLEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 N 28TH ST STE 300
RICHMOND VA
23223-5311
US

IV. Provider business mailing address

1510 N 28TH ST STE 300
RICHMOND VA
23223-5311
US

V. Phone/Fax

Practice location:
  • Phone: 804-225-7177
  • Fax:
Mailing address:
  • Phone: 804-225-7177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198059
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: