Healthcare Provider Details

I. General information

NPI: 1578482212
Provider Name (Legal Business Name): BROOKE PADGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE MANION

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 11646
LYNCHBURG VA
24506-1646
US

IV. Provider business mailing address

3905 BOONSBORO RD APT 602
LYNCHBURG VA
24503-2400
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5895
  • Fax: 434-200-7529
Mailing address:
  • Phone: 434-661-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012327
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: