=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245297720
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VETERANS HEALTH ADMINISTRATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2900 VETERANS WAY
-----------------------------------------------------
City | VIERA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-8007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-626-3130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 VETERANS WAY
-----------------------------------------------------
City | VIERA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32940-8007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MENTAL HEALTH NURSE
-----------------------------------------------------
Name | KARLA HENSEL
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 321-626-3130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 3063512
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------