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NPI Code Detail

MEDICARE: LATOYA YVETTE BRAGG APRN, PMHNP-BC

MEDICARE:   LATOYA YVETTE BRAGG  APRN, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner0001212379VA

General Provider Information

NPI Number : 1033752951
Entity Type Code : Individual
Provider Name (Legal Business Name) : LATOYA YVETTE BRAGG APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 13157 RIVERS BEND BLVD
Second Line :
City : CHESTER
State : VA
Zip : 23836-2674
Country : US
Telephone Number : 804-659-7581
Fax Number : 804-999-0463
Provider Business Practice Location Address
First Line : 13157 RIVERS BEND BLVD
Second Line :
City : CHESTER
State : VA
Zip : 23836-2674
Country : US
Telephone Number : 804-659-7581
Fax Number : 804-999-0463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2019
Last Update Date : 08/15/2022

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