Healthcare Provider Details

I. General information

NPI: 1467477273
Provider Name (Legal Business Name): VANESSA PEYTON FOWLKES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/13/2024
Certification Date: 06/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 RICHMOND HENRICO TPKE
RICHMOND VA
23227-3627
US

IV. Provider business mailing address

201 N HAMILTON ST
RICHMOND VA
23221-2601
US

V. Phone/Fax

Practice location:
  • Phone: 804-613-5907
  • Fax:
Mailing address:
  • Phone: 804-254-1760
  • Fax: 401-235-6899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024164743
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164743
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: