NPIMap

Organization Active NPI

Southeast Virginia Psychiatry PLLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Virginia Beach, VA
National Provider Identifier
1245095512
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
SOUTHEAST VIRGINIA PSYCHIATRY PLLC
Practice address
5345 Fairfield Blvd
Virginia Beach, VA 23464-2509
Phone
(757) 633-3662
NPI assigned
Feb 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Authorized official

Name
Mr. Edward James Evard, PNHNPNPI 1396344693
Title
Owner
Phone
(757) 633-3662

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

5345 Fairfield Blvd
Virginia Beach, VA 23464-2509

Mailing address

5345 Fairfield Blvd
Virginia Beach, VA 23464-2509
Phone (757) 633-3662

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240606000071 VA Part B Supplier - Clinic/Group Practice 2961944988 Receives reassigned benefits from 12 practitioners
Practice locations: Norfolk, VA; Virginia Beach, VA

National Provider Directory

National Provider Directory

Locations

400 N Center Dr
Ste 201
Norfolk, VA 23502
Phone (757) 663-3662

400 N Center Dr
Norfolk, VA 23502
Phone (757) 227-3072

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1707955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1245095512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5345 FAIRFIELD BLVD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234642509",
            "telephone_number": "757-633-3662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5345 FAIRFIELD BLVD",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234642509",
            "telephone_number": "757-633-3662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST VIRGINIA PSYCHIATRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-15",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "EVARD",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-633-3662",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PNHNP"
    },
    "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 Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.