Olga Vladimirovna Wymore

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

24193441 Issued in VA

Practice address

13000 Harbor Center Dr Ste 103
Woodbridge, VA 22192-2847

Phone

(804) 982-4370

NPI assigned

May 9, 2025

Last updated

May 12, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, DC2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Potomac Shores Mental Health and Wellness LLCGroup PAC ID 7719379072, 5 clinicians

Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Potomac Shores Mental Health & Wellness LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Woodbridge, VA
  • NPI 1902562507
  Medicare reassignment Care Compare group NPD
• Privia Medical Group, LLC

  • Internal Medicine Physician
  • Arlington, VA
  • NPI 1013042480

  DC

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1746748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1528858859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2808 NOBLE FIR CT",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221923816",
            "telephone_number": "804-982-4370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13000 HARBOR CENTER DR STE 103",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221922847",
            "telephone_number": "804-982-4370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYMORE",
        "first_name": "OLGA",
        "middle_name": "VLADIMIROVNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-09",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "24193441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Suzanne L Wright, LCSW, LICSW
• WSSH Powerback Rehabilitation Services, LLC
• Richard Wyatt, LPC, CSOTP
• Elizabeth Sue Wyman, LPC
• Mary Jane Wyman, M.D.
• Todd E Wynkoop, DDS
• Alan Howard Wynn, M.D.
• Andrew Ross Wynn, LCSW
• Erica Larae Wynn, M.D.
• Lisa Xantus, LPC

• Psychiatric/Mental Health Nurse Practitioner in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.