Supatha Kimble Peters, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024175296 Issued in VA

Practice address

576 Jefferson Ave
Fort Eustis, VA 23604-1373

Phone

(757) 314-7500

NPI assigned

May 31, 2018

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

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

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Roanoke Valley Healthcare Partners, LLC

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1619274446
  Medicare reassignment NPD
• Blue Ridge Healthcare Partners, LLC

  • Primary Care Clinic/Center
  • Roanoke, VA
  • NPI 1518304955
  NPD (past)
• Professional Health Care, Inc.

  • Specialist
  • Petersburg, VA
  • NPI 1083754790
  NPD (past)
• Short Pump Family Care, LLC

  • Primary Care Clinic/Center
  • Midlothian, VA
  • NPI 1487068334
  NPD (past)

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1861984445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 JEFFERSON AVE",
            "city": "FORT EUSTIS",
            "state": "VA",
            "postal_code": "236041373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 JEFFERSON AVE",
            "city": "FORT EUSTIS",
            "state": "VA",
            "postal_code": "236041373",
            "telephone_number": "757-314-7500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Jarrett White Rd",
            "address_purpose": "LOCATION",
            "city": "Tripler Army Medical Center",
            "state": "HI",
            "postal_code": "96859",
            "country_code": "US",
            "telephone_number": "808-433-6661",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6600 Van Aalst Blvd Bldg 9250",
            "address_purpose": "LOCATION",
            "city": "Fort Benning",
            "state": "GA",
            "postal_code": "319052102",
            "country_code": "US",
            "telephone_number": "762-408-2273",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24 S Adams St",
            "address_purpose": "LOCATION",
            "city": "Petersburg",
            "state": "VA",
            "postal_code": "238034525",
            "country_code": "US",
            "telephone_number": "804-732-2180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "24 S Adams St",
            "address_purpose": "LOCATION",
            "city": "Petersburg",
            "state": "VA",
            "postal_code": "238034525",
            "country_code": "US",
            "telephone_number": "804-732-2180",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1320 LaSalle Ave",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236693801",
            "country_code": "US",
            "telephone_number": "757-727-2577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERS",
        "first_name": "SUPATHA",
        "middle_name": "KIMBLE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-31",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024175296",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danielle Parker
• Mimi I Peak, M.D, M.P.H.
• Aasta Rae Pedersen, M.D.
• Christopher Scott Peppel, DDS
• Keisha Amiee Permenter-Keene, RN
• Mackensi Carden Pfefferkorn
• Heather Pham, D.D.S.
• Susan J Pietrowski, OD
• Cecilia P Pilola, NURSE
• Merri Elizabeth Pope, PTA

• Family Nurse Practitioner in Fort Eustis, VA
• Providers in Fort Eustis, 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 Nov 19, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.