Provider Demographics
NPI:1457758393
Name:BLUE SKY PSYCHIATRY
Entity Type:Organization
Organization Name:BLUE SKY PSYCHIATRY
Other - Org Name:KAREN BEATTY, MSN, FNP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:757-773-3456
Mailing Address - Street 1:440 MONTICELLO AVE STE 1844
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-2571
Mailing Address - Country:US
Mailing Address - Phone:757-773-3456
Mailing Address - Fax:757-282-5748
Practice Address - Street 1:440 MONTICELLO AVE STE 1844
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2571
Practice Address - Country:US
Practice Address - Phone:757-773-3456
Practice Address - Fax:757-282-5748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 363LF0000X
VA0024168880363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1619157757Medicaid
VA1457758393OtherGROUP NPI
VA1114956638OtherDR PATRICIA KING - COLLABORATOR