Healthcare Provider Details

I. General information

NPI: 1396325239
Provider Name (Legal Business Name): CHASSIDY MOBLEY BSN-RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3653 VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23452-3418
US

IV. Provider business mailing address

4727 MARLWOOD WAY
VIRGINIA BEACH VA
23462-7237
US

V. Phone/Fax

Practice location:
  • Phone: 757-463-2011
  • Fax:
Mailing address:
  • Phone: 706-294-7933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001253207
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0001253207
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: