NPIMap

Organization Active NPI

Drynachan LLC

  • Nurse Practitioner
  • Chantilly, VA
National Provider Identifier
1891044657
Registry record updated Mar 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
DRYNACHAN LLC
Practice address
14121 Parke Long CT
Suite 201
Chantilly, VA 20151-1647
Phone
(571) 449-3585
NPI assigned
Sep 7, 2012
Last updated
Mar 26, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2018

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

Authorized official

Name
Mr. Brian J Wise
Title
Ceo
Phone
(571) 449-2928

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X
Nurse Practitioner 363L00000X Primary

Addresses

Primary practice location

14121 Parke Long CT
Suite 201
Chantilly, VA 20151-1647

Mailing address

14121 Parke Long CT
Suite 201
Chantilly, VA 20151-1647
Phone (571) 449-3585

Other identifiers 8

IdentifierTypeStateIssuer
003185092AMedicaidGA
500040770MedicaidMO
GP7738MedicaidSC
1891044657MedicaidWA
1891055657MedicaidIL
1991044657MedicaidVA
300001898MedicaidIN
18159900MedicaidFL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

128 State St
#3
Augusta, ME 04330

645 Lakeland East Dr
Flowood, MS 39232

5601 S 59th St
Lincoln, NE 68516
Phone (507) 235-9334

2700 Doolittle Dr
Ellsworth AFB, SD 57706
Phone (605) 385-3331

300 Montvue Rd
Ste 200
Knoxville, TN 37919

3080 Centreville Rd
Ste 200
Herndon, VA 20171
Phone (571) 449-2040

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1891044657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14121 PARKE LONG CT",
            "address_2": "SUITE 201",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511647",
            "telephone_number": "571-449-3585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14121 PARKE LONG CT",
            "address_2": "SUITE 201",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511647",
            "telephone_number": "571-449-3585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRYNACHAN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-07",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "WISE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "571-449-2928",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003185092A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500040770",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP7738",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891044657",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891055657",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1991044657",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300001898",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18159900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; 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.