Healthcare Provider Details

I. General information

NPI: 1356990261
Provider Name (Legal Business Name): CHANTZ BURY PMHNP-BC, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MCLAWS CIR STE 3
WILLIAMSBURG VA
23185-6346
US

IV. Provider business mailing address

354 MCLAWS CIR STE 3
WILLIAMSBURG VA
23185-6346
US

V. Phone/Fax

Practice location:
  • Phone: 757-585-3010
  • Fax:
Mailing address:
  • Phone: 757-585-3030
  • Fax: 757-733-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024178195
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178195
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: