Healthcare Provider Details

I. General information

NPI: 1295924538
Provider Name (Legal Business Name): VANESSA PRICE HAIRSTON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA KAYE PRICE

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 MEDICAL CENTER RD
AXTON VA
24054-2822
US

IV. Provider business mailing address

PO BOX 10399
DANVILLE VA
24543-5007
US

V. Phone/Fax

Practice location:
  • Phone: 434-685-7095
  • Fax: 434-685-2990
Mailing address:
  • Phone: 434-685-7095
  • Fax: 434-685-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024097372
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: