Healthcare Provider Details

I. General information

NPI: 1952229379
Provider Name (Legal Business Name): HALLIE CAROLINE VESTAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 DISCOVERY DR STE 400
RICHMOND VA
23229-8600
US

IV. Provider business mailing address

8006 DISCOVERY DR STE 400
RICHMOND VA
23229-8600
US

V. Phone/Fax

Practice location:
  • Phone: 804-256-8282
  • Fax:
Mailing address:
  • Phone: 804-256-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012147
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: