Healthcare Provider Details

I. General information

NPI: 1861023046
Provider Name (Legal Business Name): JEANNIE EVETTE MASON-WALKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 CHAMBERLAYNE AVE
RICHMOND VA
23222-4205
US

IV. Provider business mailing address

8711 BEACH RD
CHESTERFIELD VA
23838-5355
US

V. Phone/Fax

Practice location:
  • Phone: 804-329-8510
  • Fax:
Mailing address:
  • Phone: 804-386-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178781
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: