Healthcare Provider Details

I. General information

NPI: 1023438454
Provider Name (Legal Business Name): VIRGINIA FOOTE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2014
Last Update Date: 02/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WADSWORTH DR
NORTH CHESTERFIELD VA
23236
US

IV. Provider business mailing address

107 WADSWORTH DR
NORTH CHESTERFIELD VA
23236-4521
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-4201
  • Fax: 804-272-6895
Mailing address:
  • Phone: 804-330-4901
  • Fax: 804-330-9145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110006338
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: