PALADIN DERMATOLOGY LLC (NPI# 1225417082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225417082 |
| Entity Type | Organization |
| Organization Name | PALADIN DERMATOLOGY LLC |
| Practice Address |
44 A& B Medical Park Blvd Petersburg VA 23805 |
| Mailing Address |
1801 Libbie Ave Ste 204 Richmond VA 23226-1836 |
| Practice Telephone | 8046484802 |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2015-10-27 |
| Authorized Official Name | JOE HERNANDEZ (MANAGING OFFICIAL) |
| Authorized Official Telephone | 8046484802 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 0024164803 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
44 A& B MEDICAL PARK BLVD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| 1366683567 | Family Hearing Aid Cntr. | Hearing Instrument Specialist | 1936 S. Sycamore St., Petersburg, VA 23805 | 2009-03-18 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497124192 | Lynnette M Matteson | Nurse Practitioner | 611 E Main Street, Suite 110, Petersburg, IN 47567-1270 | 2015-09-23 |
| 1780800300 | Terry M Tuck | Nurse Practitioner | 2820 Normandy Dr, Petersburg, VA 23805-9372 | 2007-04-18 |
| 1699245068 | Lindsay Ann Morris | Nurse Practitioner | 40 Medical Park Blvd Ste D, Petersburg, VA 23805 | 2018-11-28 |
| 1578081345 | Alexandria Jo Carie-kroeger | Nurse Practitioner | 106 W Pike Ave, Petersburg, IN 47567-8750 | 2017-08-31 |
| 1528420544 | Jaimie Sarcon Tahir | Nurse Practitioner | 601 Old Wagner Rd, Petersburg, VA 23805-9313 | 2016-03-28 |
| 1346683182 | Brenna B Bohatec | Nurse Practitioner | 210 Medical Park Blvd, Suite 200, Petersburg, VA 23805-9338 | 2013-04-11 |
| 1063727204 | Nicole L Stevenson | Nurse Practitioner | 1003 E Illinois St, Petersburg, IN 47567-8068 | 2010-08-12 |
| 1437300043 | Menard Medical Center, LLC | Nurse Practitioner | 1 Centre Dr, Petersburg, IL 62675-9467 | 2008-10-02 |
| 1750545281 | Kathyrn Scribner | Nurse Practitioner | 44 Medical Park Blvd, Suite A, Petersburg, VA 23805-9349 | 2008-07-14 |
| 1295951804 | Catherine E Cheek | Nurse Practitioner | 301 Halifax St, Petersburg, VA 23803-6335 | 2007-04-18 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.