Provider Demographics
NPI:1205974102
Name:MARTIN, AVA RUTH (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:AVA
Middle Name:RUTH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 FIELDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263-1215
Mailing Address - Country:US
Mailing Address - Phone:276-546-5310
Mailing Address - Fax:276-454-6297
Practice Address - Street 1:RT 3 BOX 1700
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263
Practice Address - Country:US
Practice Address - Phone:276-346-3590
Practice Address - Fax:276-346-3612
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001169717163W00000X
VA0024170809363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse