Provider Demographics
NPI:1992169056
Name:AEKINS, MATTIE L (FNP-BC)
Entity type:Individual
Prefix:
First Name:MATTIE
Middle Name:L
Last Name:AEKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 CLEVELAND ST STE 600
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1788
Mailing Address - Country:US
Mailing Address - Phone:757-963-6507
Mailing Address - Fax:757-963-6375
Practice Address - Street 1:664 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4818
Practice Address - Country:US
Practice Address - Phone:757-393-6363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173353363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1992169056OtherUSA MANAGED CARE
VA1992169056OtherTRICARE/CHAMPUS
VA1992169056Medicaid
VA1992169056OtherMULTIPLAN
VA1992169056OtherOPTIMA HEALTH
VA1992169056OtherUSA MANAGED CARE