Healthcare Provider Details

I. General information

NPI: 1023502911
Provider Name (Legal Business Name): TRIXY M. HEADDEN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CHURCH AVE SW
ROANOKE VA
24011-1906
US

IV. Provider business mailing address

210 EMERALD CREST CT
YOUNGSVILLE NC
27596-7918
US

V. Phone/Fax

Practice location:
  • Phone: 540-823-1373
  • Fax:
Mailing address:
  • Phone: 919-422-5423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5010607
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number5010607
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5010607
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: