MEDICARE: CARRIE RADFORD FNP

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	F06202346	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		OTHER

General Provider Information

NPI Number	:	1679190136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE RADFORD FNP

Provider Business Mailing Address
First Line	:	1908 KILLEY ST
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-3608
Country	:	US
Telephone Number	:	757-839-6745
Fax Number	:

Provider Business Practice Location Address
First Line	:	4534 BONNEY RD STE B
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3873
Country	:	US
Telephone Number	:	757-499-4101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2020
Last Update Date	:	03/28/2023

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