Provider Demographics
NPI:1164788519
Name:MOUZON, NAKESHIA LYNN (FNP, PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:NAKESHIA
Middle Name:LYNN
Last Name:MOUZON
Suffix:
Gender:F
Credentials:FNP, PMHNP
Other - Prefix:MRS
Other - First Name:NAKESHIA
Other - Middle Name:LYNN
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C, PMHNP-BC
Mailing Address - Street 1:1216 GRANBY ST STE 20
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2622
Mailing Address - Country:US
Mailing Address - Phone:757-204-1901
Mailing Address - Fax:908-504-8194
Practice Address - Street 1:1216 GRANBY ST STE 20
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2622
Practice Address - Country:US
Practice Address - Phone:757-581-1779
Practice Address - Fax:908-504-8194
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170001363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164788519Medicaid
VA1164788519Medicaid