Healthcare Provider Details

I. General information

NPI: 1902348121
Provider Name (Legal Business Name): VANESSA PATEL AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 08/30/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 PEMBERTON RD
RICHMOND VA
23233-2003
US

IV. Provider business mailing address

9301 RUDDERS POINT CV
MECHANICSVILLE VA
23116-2100
US

V. Phone/Fax

Practice location:
  • Phone: 804-747-9200
  • Fax:
Mailing address:
  • Phone: 804-513-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024174219
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024174219
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: