Healthcare Provider Details

I. General information

NPI: 1972423713
Provider Name (Legal Business Name): AMY NICHOLE CARLISON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 FRANKLIN ST STE 106
WEYERS CAVE VA
24486-2347
US

IV. Provider business mailing address

43 GRANARY RD
VERONA VA
24482-2532
US

V. Phone/Fax

Practice location:
  • Phone: 540-217-8716
  • Fax:
Mailing address:
  • Phone: 540-292-7064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198483
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: