Amesha Renee Whitlock, NURSE PRACTITIONER

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

0024180214 Issued in VA

Practice address

549 E Brambleton Ave
Norfolk, VA 23510-2905

Phone

(757) 678-2001

NPI assigned

Sep 24, 2020

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

Other names 1

• Amesha Custis Former name

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

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Mid-Atlantic Post Acute & Long Term Care PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225557556

  Gerontology

  Medicare reassignment NPD
• PMR Virginia Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1083167001

  VA

  Medicare reassignment NPD
• Jencare Neighborhood Medical East Richmond, LLC

  • Internal Medicine Physician
  • Richmond, VA
  • NPI 1891089454
  NPD (past)
• Peace of Mind Mental Health Services LLC

  • Counselor
  • Hampton, VA
  • NPI 1053996231
  NPD (past)

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

{
    "created_epoch": "1600905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1952918880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "549 E BRAMBLETON AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235102905",
            "telephone_number": "757-678-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "549 E BRAMBLETON AVE",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235102905",
            "telephone_number": "757-678-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITLOCK",
        "first_name": "AMESHA",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-24",
        "last_updated": "2023-06-02",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024180214",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "VA",
            "license": "0024180214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMESHA",
            "last_name": "CUSTIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• John Whitenton
• Mary Catherine Whiteside
• Whitestone Prayer Ministries
• Whitestone Prayer Ministries
• Walter O Whitley, MD
• Carol C Whitney, LCSW
• Tammy Denise Whitt
• Rachel Whitten, SLP
• Jan L. Whitus, SLP-CCC
• Darcy John Alexander Wiart, ATC

• Gerontology Nurse Practitioner in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Gerontology Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; 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.