Healthcare Provider Details

I. General information

NPI: 1396677290
Provider Name (Legal Business Name): RHONDA MOORE MSN APRN FNP-BC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2602 WHITEHOUSE RD STE D
SOUTH CHESTERFIELD VA
23834-5398
US

IV. Provider business mailing address

2602 WHITEHOUSE RD STE D
SOUTH CHESTERFIELD VA
23834-5398
US

V. Phone/Fax

Practice location:
  • Phone: 804-468-9574
  • Fax: 804-207-8750
Mailing address:
  • Phone: 804-468-9574
  • Fax: 804-207-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RHONDA MOORE
Title or Position: FNP-PMHNP
Credential: OWNER
Phone: 804-468-9574