Provider Demographics
NPI:1083288740
Name:BELT, KANISHA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KANISHA
Middle Name:
Last Name:BELT
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 S INDEPENDENCE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1178
Mailing Address - Country:US
Mailing Address - Phone:757-761-5815
Mailing Address - Fax:
Practice Address - Street 1:249 CENTRAL PARK AVE STE 300-160
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3099
Practice Address - Country:US
Practice Address - Phone:757-663-7547
Practice Address - Fax:757-802-3897
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181473363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health