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General NPI Number Information
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NPI Number | 1396585105
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Entity Type | Organization
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Legal Business Name | PRACTITIONER'S HEART HOMEBASED HEALTHCARE LLC
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Dates
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Enumeration Date | 05/29/2024
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1103 W ROSLYN RD
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-3909
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Country | US
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Telephone | 804-439-2120
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Fax | 276-325-5604
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Provider Business Mailing Address
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Address Line | PO BOX 254
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-0254
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Country | US
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Telephone | 804-439-2120
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Fax | 276-325-5604
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Authorized Official
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Title or Position | CEO
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Name | LAURA BERRY
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Credential | NURSE PRACTITIONER
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Telephone | 804-439-2120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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