Provider Demographics
NPI:1679267546
Name:EASLEY, NAKISHA (FNP)
Entity type:Individual
Prefix:
First Name:NAKISHA
Middle Name:
Last Name:EASLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 N MAIN ST STE H
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2547
Mailing Address - Country:US
Mailing Address - Phone:434-517-6180
Mailing Address - Fax:434-517-6179
Practice Address - Street 1:1129 N MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2547
Practice Address - Country:US
Practice Address - Phone:434-517-6180
Practice Address - Fax:434-517-6179
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186791207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine