Healthcare Provider Details

I. General information

NPI: 1669203774
Provider Name (Legal Business Name): NATHANIEL MOYAR AGACNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 08/10/2024
Certification Date: 08/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 FOREST AVE STE 200
RICHMOND VA
23230-1726
US

IV. Provider business mailing address

7001 FOREST AVE STE 200
RICHMOND VA
23230-1726
US

V. Phone/Fax

Practice location:
  • Phone: 434-738-8174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2024030897
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2024030897
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: