Healthcare Provider Details

I. General information

NPI: 1558973180
Provider Name (Legal Business Name): NINA LOUISE WYATT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 FOREST AVE STE 300
RICHMOND VA
23230-1730
US

IV. Provider business mailing address

6900 FOREST AVE STE 300
RICHMOND VA
23230-1730
US

V. Phone/Fax

Practice location:
  • Phone: 804-346-1515
  • Fax: 804-270-2888
Mailing address:
  • Phone: 804-346-1515
  • Fax: 804-270-2888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197139
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024197139
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: