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General NPI Number Information
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NPI Number | 1932690658
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Entity Type | Organization
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Legal Business Name | ALLEGIANT HEALTH SERVICES
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 2147 OLD GREENBRIER RD
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City | CHESAPEAKE
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State | VA
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Zip | 23320-2635
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Country | US
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Telephone | 757-306-1300
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Fax | 507-609-3013
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Provider Business Mailing Address
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Address Line | 4209 RAVINE GAP DR
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City | SUFFOLK
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State | VA
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Zip | 23434-3055
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Country | US
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Telephone | 757-344-0822
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Fax | 507-609-3013
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. TYSHEENA LANEE JONES
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Credential | FNP-C
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Telephone | 757-344-0822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024174111
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License Number State | VA
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