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550 First Colonial Road Suite 308 4651 Virginia Beach VA 23454-5664 | |
| (757) 769-0571 | |
| (757) 432-3199 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 550 First Colonial Road Suite 308, Virginia Beach, Virginia |
| Authorized Official Name and Position | Kenita Murray (OWNER) |
| Authorized Official Contact | 7577690157 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 4651 Virginia Beach VA 23454-0651 Ph: (757) 769-0571 | 550 First Colonial Road Suite 308 4651 Virginia Beach VA 23454-5664 Ph: (757) 769-0571 |
| NPI Number | 1023882263 |
|---|---|
| Provider Enumeration Date | 11/08/2023 |
| Last Update Date | 12/29/2024 |
| Certification Date | 12/29/2024 |
| Medicare PECOS PAC ID | 4486196151 |
|---|---|
| Medicare Enrollment ID | O20240610001387 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023882263 | NPI | - | NPPES |
| 1437769627 | Medicaid | VA | |
| 1568087369 | Other | VA | INSURANCE |
| 1437769627 | Other | VA | INSURANCE |
| 1568087369 | Medicaid | VA |
| Provider Name | Kenita D Murray |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437769627 PECOS PAC ID: 0244615839 Enrollment ID: I20220919000598 |
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