Healthcare Provider Details

I. General information

NPI: 1245866714
Provider Name (Legal Business Name): KIERRIAH CALLIER DORTCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 N 25TH ST
RICHMOND VA
23223-5254
US

IV. Provider business mailing address

1122 N 25TH ST
RICHMOND VA
23223-5254
US

V. Phone/Fax

Practice location:
  • Phone: 877-757-8577
  • Fax:
Mailing address:
  • Phone: 877-757-8577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11017591
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number905181
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704344323
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2472837
License Number StateMN
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-148061
License Number StateAL
# 6
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024197754
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberGAA-NP001530
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number1-148061
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: