Healthcare Provider Details

I. General information

NPI: 1891423315
Provider Name (Legal Business Name): JOSIE MARIE BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

293 INDEPENDENCE BLVD STE 400
VIRGINIA BEACH VA
23462-5461
US

IV. Provider business mailing address

33651 MONROE RD
NEWSOMS VA
23874-2426
US

V. Phone/Fax

Practice location:
  • Phone: 757-785-3338
  • Fax:
Mailing address:
  • Phone: 757-651-1357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-227900
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: