Healthcare Provider Details

I. General information

NPI: 1679287718
Provider Name (Legal Business Name): ALLISON K. DOUTHAT CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2023
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4687 POUNCEY TRACT RD
GLEN ALLEN VA
23059-5802
US

IV. Provider business mailing address

13803 GARRISON PLACE DR
MIDLOTHIAN VA
23112-4043
US

V. Phone/Fax

Practice location:
  • Phone: 804-422-5437
  • Fax:
Mailing address:
  • Phone: 804-201-5650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024186167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: