Healthcare Provider Details

I. General information

NPI: 1538701248
Provider Name (Legal Business Name): CHARITY ANN BALENTINE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARITY ANN SMITH

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 03/07/2023
Certification Date: 02/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E JUBAL EARLY DR
WINCHESTER VA
22601-5178
US

IV. Provider business mailing address

220 CAMPUS BLVD STE 100
WINCHESTER VA
22601-2888
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-2232
  • Fax:
Mailing address:
  • Phone: 540-536-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104792
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: