Basic Information
| Provider Information | |||||||||
| NPI: | 1669080933 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ASAFOTEI | ||||||||
| FirstName: | HARUNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 HEALTH PARK DR FL HP2 | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153737600 | ||||||||
| FaxNumber: | 8777672310 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 ARH LANE | ||||||||
| Address2: | 5TH FLOOR TRANSITIONAL UNIT | ||||||||
| City: | LOW MOOR | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5408622021 | ||||||||
| FaxNumber: | 5408626715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2020 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | PENDING | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | 0024179871 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.