Healthcare Provider Details

I. General information

NPI: 1851859268
Provider Name (Legal Business Name): DAKOTA DAYLE BRIGHTSTAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 JOHNSTON WILLIS DR STE 200
NORTH CHESTERFIELD VA
23235-4871
US

IV. Provider business mailing address

1051 JOHNSTON WILLIS DR STE 200
NORTH CHESTERFIELD VA
23235-4871
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-2705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-007227
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: