Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0001212379 | VA |
NPI | 1033752951 |
---|---|
Provider Name | Latoya Yvette Bragg |
First Address | Richmond, VA 23230-4339 |
Second Address | Richmond, VA 23230-4339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2019 |
Last Update Date | 02/12/2021 |