YOUR BUSINESS CCC NPI 1639987530

NPI Information

  • NPI: 1639987530
  • Provider Name: YOUR BUSINESS CCC
  • Classification: Nurse Practitioner - 363LP2300X
  • Specialization: Primary Care
  • Entity Type: Organization
  • :
  • Address: 424 MARKET ST STE 100
    SUFFOLK, VA
    ZIP 23434
  • Phone: (757) 347-0703

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NPI Details

YOUR BUSINESS CCC is a primary care nurse practitioner in Suffolk, VA. YOUR BUSINESS CCC NPI is 1639987530. The provider is registered as an organization entity type and is a multi-specialty group.
The provider .

The provider's business location address is:

424 MARKET ST STE 100
SUFFOLK, VA
ZIP 23434-249
Phone: (757) 347-0703
Fax: (757) 276-6514

The provider's authorized official is Whitney Smith .
The authorized official title is Ceo and has the following contact phone number (757) 347-0703.

The enumeration date for this NPI number is 12/23/2024 and was last updated on 3/20/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11041C0700XSocial WorkerClinicalNo
2363LP0808XNurse PractitionerPsychiatric/Mental HealthNo
3363LP2300XNurse PractitionerPrimary CareYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11922695592MEDICAIDVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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