Provider Demographics
NPI:1538701248
Name:BALENTINE, CHARITY ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CHARITY
Middle Name:ANN
Last Name:BALENTINE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHARITY
Other - Middle Name:ANN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:
Practice Address - Street 1:607 E JUBAL EARLY DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-5178
Practice Address - Country:US
Practice Address - Phone:540-536-2232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV104792363LF0000X
VA0024178148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMB55990002OtherDEA - VA