Petheree Nissley, FNP-C, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

0024173882 Issued in VA

Practice address

2256 Irish Rd
Esmont, VA 22937-1945

Phone

(434) 286-3602

Fax

(434) 286-3819

NPI assigned

Sep 7, 2016

Last updated

Jan 19, 2022By 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 2

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

Specialty

Nurse Practitioner

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Central Virginia Health Services IncGroup PAC ID 0345158432, 94 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.

• Central Virginia Health Services Inc

  dba CVHS Downtown Petersburg

  • Federally Qualified Health Center (FQHC)
  • Petersburg, VA
  • NPI 1134258601
  Medicare reassignment Care Compare group NPD
• Central Virginia Health Services Inc

  dba CVHS Buckingham

  • Federally Qualified Health Center (FQHC)
  • New Canton, VA
  • NPI 1235259607
  NPD
• Central Virginia Health Services Inc

  dba CVHS Blue Devils Health Center

  • Federally Qualified Health Center (FQHC)
  • Hopewell, VA
  • NPI 1972264869
  NPD

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642550400000",
    "number": "1932656048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2256 IRISH RD",
            "city": "ESMONT",
            "state": "VA",
            "postal_code": "229371945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2256 IRISH RD",
            "city": "ESMONT",
            "state": "VA",
            "postal_code": "229371945",
            "telephone_number": "434-286-3602",
            "fax_number": "434-286-3819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISSLEY",
        "first_name": "PETHEREE",
        "credential": "FNP-C, PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024173882",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024173882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leonor Mejia Gett
• Katherine Adelicia Hedian, D.O.
• Margaret J Hobson, MD
• Carol Renee Lundgren, LPC
• Moonshot Therapy & Wellness LLC
• Dawn Osterholt, M.D.
• Lorelei Pulliam, BCBA
• Loretta Raiford, PMHNP
• Vision Services Group
• Mary Katherine Ward, MSN FNP-BC

• Psychiatric/Mental Health Nurse Practitioner in Esmont, VA
• Providers in Esmont, 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 Jan 19, 2022; 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.