MEDICARE: NOBLE MEDICAL AND PSYCHIATRIC MENTAL HEALTH SERVICES LLC

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	363LF0000X	Family Nurse Practitioner
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1548193915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOBLE MEDICAL AND PSYCHIATRIC MENTAL HEALTH SERVICES LLC

Provider Business Mailing Address
First Line	:	2500 VANTAGE DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-1551
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 VANTAGE DR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-1551
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Authorized Official
Title or Position	:	PMHNP-BC FNP-C,APRN
Name	:	ESI YEBOAH
Credential	:
Telephone Number	:	804-207-6737

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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