Individual provider Active NPI

Rose Akhoasegbe Ehichioya, PMHNP, PHD

  • Psychiatric/Mental Health Nurse Practitioner
  • Woodbridge, VA
National Provider Identifier
1649960410
Registry record updated Jul 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
0024187059 Issued in VA
Practice address
3130 Golansky Blvd Ste 201
Woodbridge, VA 22192-4268
Phone
(703) 973-0176
Fax
(571) 428-2027
NPI assigned
May 15, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 6, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X 0024187059 VA Primary

Addresses

Primary practice location

3130 Golansky Blvd Ste 201
Woodbridge, VA 22192-4268

Mailing address

3130 Golansky Blvd Ste 201
Woodbridge, VA 22192-4268
Phone (571) 899-5076

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20250321002802 VA Practitioner - Nurse Practitioner 4385164300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0024187059VAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Destiny Connection LLC Current Accepting new patients
Obose Behavioral Health & Wellness Clinic LLC Multi-Specialty CurrentSince Nov 18, 2024 Accepting new patients
Excellent Care Home Health Services LLC Current Accepting new patients

Locations

3130 Golansky Blvd
Ste 201
Woodbridge, VA 22192
Phone (703) 973-0176

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783296000000",
    "number": "1649960410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3130 GOLANSKY BLVD STE 201",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924268",
            "telephone_number": "571-899-5076",
            "fax_number": "571-428-2027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3130 GOLANSKY BLVD STE 201",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221924268",
            "telephone_number": "703-973-0176",
            "fax_number": "571-428-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EHICHIOYA",
        "first_name": "ROSE",
        "middle_name": "AKHOASEGBE",
        "name_prefix": "Dr.",
        "credential": "PMHNP, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-15",
        "last_updated": "2026-07-06",
        "certification_date": "2026-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024187059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbridge, VA

Sources for this page

Verify at the official NPI Registry.