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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0001212379	VA

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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