Healthcare Provider Details

I. General information

NPI: 1679017651
Provider Name (Legal Business Name): MICHELLE NICOLE DOWDY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2016
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

V. Phone/Fax

Practice location:
  • Phone: 540-521-9160
  • Fax:
Mailing address:
  • Phone: 540-521-9160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0024174238
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number0024174238
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024174238
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024174238
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: