Healthcare Provider Details

I. General information

NPI: 1992181226
Provider Name (Legal Business Name): HEATHER RENEE BRAGG NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2015
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 HICKOK ST
CHRISTIANSBURG VA
24073-3524
US

IV. Provider business mailing address

6 HICKOK ST
CHRISTIANSBURG VA
24073-3524
US

V. Phone/Fax

Practice location:
  • Phone: 540-382-6148
  • Fax:
Mailing address:
  • Phone: 540-382-6148
  • Fax: 540-382-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172857
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001224260
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: