Deidra Haralson, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024176534 Issued in VA

Practice address

13900 Church Hill Dr
Woodbridge, VA 22191-2131

Phone

(703) 335-2779

NPI assigned

May 7, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: deidra.haralson.1@18665.direct.athenahealth.com

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

• Catholic Charaties Diocese of Arlington

  dba Mother of Mercy Free Medical Clinic

  • Primary Care Clinic/Center
  • Manassas, VA
  • NPI 1801630801
  NPD (past)
• Fredericksburg Area Regional Health Council

  dba Lloyd F. Moss Free Clinic

  • Primary Care Clinic/Center
  • Fredericksburg, VA
  • NPI 1225358930
  NPD (past)
• Lloyd F. Moss Free Clinic

  • Health Service Clinic/Center
  • Fredericksburg, VA
  • NPI 1487089512
  NPD (past)

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

{
    "created_epoch": "1651881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675814400000",
    "number": "1609512292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15325 BOWMANS FOLLY DR",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201125476",
            "telephone_number": "571-455-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13900 CHURCH HILL DR",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221912131",
            "telephone_number": "703-335-2779"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Sam Perry Blvd # 100",
            "address_purpose": "LOCATION",
            "city": "Fredericksburg",
            "state": "VA",
            "postal_code": "224018420",
            "country_code": "US",
            "telephone_number": "540-741-1061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARALSON",
        "first_name": "DEIDRA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-07",
        "last_updated": "2023-02-08",
        "certification_date": "2023-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024176534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://mossfreeclinic.org",
            "affiliation": "N",
            "endpointDescription": "Clinic",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1301 Sam Perry Blvd Unit 100",
            "city": "Fredericksburg",
            "state": "VA",
            "country_code": "US",
            "postal_code": "224018420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Candace Harding, PT, DPT

• Family Nurse Practitioner in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2023; 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.