Healthcare Provider Details

I. General information

NPI: 1780128389
Provider Name (Legal Business Name): ALLISON GRAY WORKMAN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON LOY

II. Dates (important events)

Enumeration Date: 12/15/2016
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-224-4325
  • Fax:
Mailing address:
  • Phone: 540-224-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: