Basic Information
Provider Information
NPI: 1235762964
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ERNEST
FirstName: ALLISON
MiddleName: DANIELLE
NamePrefix:  
NameSuffix:  
Credential: PMHNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2905 RIDGEWOOD PARK CT
Address2:  
City: GLEN ALLEN
State: VA
PostalCode: 230602130
CountryCode: US
TelephoneNumber: 8048222197
FaxNumber:  
Practice Location
Address1: 2006 BREMO RD
Address2:  
City: RICHMOND
State: VA
PostalCode: 232262438
CountryCode: US
TelephoneNumber: 8042881881
FaxNumber:  
Other Information
ProviderEnumerationDate: 02/21/2020
LastUpdateDate: 02/21/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/21/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808X0024178897VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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