Basic Information
| Provider Information | |||||||||
| NPI: | 1205974102 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTIN | ||||||||
| FirstName: | AVA | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 276 FIELDSTONE DR | ||||||||
| Address2: | |||||||||
| City: | JONESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242631215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2765465310 | ||||||||
| FaxNumber: | 2764546297 | ||||||||
| Practice Location | |||||||||
| Address1: | RT 3 BOX 1700 | ||||||||
| Address2: | |||||||||
| City: | JONESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 24263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2763463590 | ||||||||
| FaxNumber: | 2763463612 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/02/2007 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001169717 | VA | N | Nursing Service Providers | Registered Nurse | 363LP0808X | 0024170809 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.