Healthcare Provider Details

I. General information

NPI: 1992482061
Provider Name (Legal Business Name): BREAKTHROUGH CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 FORT HUGER DR
SMITHFIELD VA
23430-5364
US

IV. Provider business mailing address

4338 FORT HUGER DR
SMITHFIELD VA
23430-5364
US

V. Phone/Fax

Practice location:
  • Phone: 757-542-3888
  • Fax: 757-542-3890
Mailing address:
  • Phone: 757-542-3888
  • Fax: 757-542-3890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATRINA J GRIFFIN
Title or Position: OWNER
Credential: NP
Phone: 757-542-3888