1992169056 NPI number — MATTIE L. AEKINS FNP-BC

Table of content: MATTIE L. AEKINS FNP-BC (NPI 1992169056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992169056 NPI number — MATTIE L. AEKINS FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AEKINS
Provider First Name:
MATTIE
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992169056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5701 CLEVELAND ST STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23462-1788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-963-6507
Provider Business Mailing Address Fax Number:
757-963-6375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
664 LINCOLN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23704-4818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-393-6363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024173353 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1992169056 . This is a "USA MANAGED CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1992169056 . This is a "TRICARE/CHAMPUS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1992169056 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992169056 . This is a "MULTIPLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1992169056 . This is a "OPTIMA HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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