Individual
JIMMY WAYNE SPELTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
732 EDEN WAY N STE E507, CHESAPEAKE, VA 23320-2798
(757) 412-7840
Mailing address
732 EDEN WAY N STE 507, CHESAPEAKE, VA 23320-2798
(757) 609-2726
(757) 609-2874
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024182894
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
UNKNOWN
—
Enumeration date
10/05/2020
Last updated
10/13/2021
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