Healthcare Provider Details

I. General information

NPI: 1215002290
Provider Name (Legal Business Name): MARY ANN KEARLEY A.P.R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6465 COLLEGE PARK SQ SUITE 210
VIRGINIA BEACH VA
23464-3609
US

IV. Provider business mailing address

6465 COLLEGE PARK SQ SUITE 210
VIRGINIA BEACH VA
23464-3609
US

V. Phone/Fax

Practice location:
  • Phone: 757-420-0530
  • Fax: 757-420-0488
Mailing address:
  • Phone: 757-420-0530
  • Fax: 757-420-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701001342
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number0015000183
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: