Healthcare Provider Details

I. General information

NPI: 1477469260
Provider Name (Legal Business Name): HISAE COLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 11646
LYNCHBURG VA
24506-1646
US

IV. Provider business mailing address

PO BOX 11646
LYNCHBURG VA
24506-1646
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012315
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: