Healthcare Provider Details

I. General information

NPI: 1598842841
Provider Name (Legal Business Name): BETSY WRIGHT SHIRES RN CNS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 W. 46TH ST.
RICHMOND VA
23225
US

IV. Provider business mailing address

1207 W. 46TH ST.
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 804-432-8482
  • Fax: 804-828-9284
Mailing address:
  • Phone: 804-432-8482
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number024181998
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0015000356
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: