NPIMap

Organization Active NPI

South Chesapeake Psychiatry

  • Psychiatric/Mental Health Nurse Practitioner
  • Chesapeake, VA
National Provider Identifier
1033707450
Registry record updated Apr 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
SOUTH CHESAPEAKE PSYCHIATRY
Practice address
200 Carmichael Way Ste 604
Chesapeake, VA 23322-2489
Phone
(850) 776-2545
Fax
(757) 257-1163
NPI assigned
Jan 3, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Justin Ray, PMHNP-BCNPI 1093013641
Title
Owner
Phone
(850) 776-2545

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

200 Carmichael Way Ste 604
Chesapeake, VA 23322-2489

Mailing address

200 Carmichael Way Ste 604
Chesapeake, VA 23322-2489
Phone (757) 908-2124

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617321600000",
    "number": "1033707450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 CARMICHAEL WAY STE 604",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233222489",
            "telephone_number": "757-908-2124",
            "fax_number": "757-908-2320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 CARMICHAEL WAY STE 604",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233222489",
            "telephone_number": "850-776-2545",
            "fax_number": "757-257-1163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CHESAPEAKE PSYCHIATRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-03",
        "last_updated": "2021-04-02",
        "certification_date": "2021-04-02",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-776-2545",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.