Provider Demographics
NPI:1932656048
Name:NISSLEY, PETHEREE (FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PETHEREE
Middle Name:
Last Name:NISSLEY
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2256 IRISH RD
Mailing Address - Street 2:
Mailing Address - City:ESMONT
Mailing Address - State:VA
Mailing Address - Zip Code:22937-1945
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2256 IRISH RD
Practice Address - Street 2:
Practice Address - City:ESMONT
Practice Address - State:VA
Practice Address - Zip Code:22937-1945
Practice Address - Country:US
Practice Address - Phone:434-286-3602
Practice Address - Fax:434-286-3819
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173882363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily