Provider Demographics
NPI:1700486198
Name:SESSOMS, FREDRICK
Entity Type:Individual
Prefix:
First Name:FREDRICK
Middle Name:
Last Name:SESSOMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 BRIARCREST DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4803
Mailing Address - Country:US
Mailing Address - Phone:757-802-0068
Mailing Address - Fax:
Practice Address - Street 1:7001 JAHNKE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4146
Practice Address - Country:US
Practice Address - Phone:855-355-7001
Practice Address - Fax:804-251-0989
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179882363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health