Healthcare Provider Details

I. General information

NPI: 1154493658
Provider Name (Legal Business Name): LAUREN HEATHER OATES PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HOSPITAL DR STE C
WARRENTON VA
20186-3026
US

IV. Provider business mailing address

400C HOSPITAL DR STE 220
WARRENTON VA
20186-3026
US

V. Phone/Fax

Practice location:
  • Phone: 540-428-1715
  • Fax: 540-779-0028
Mailing address:
  • Phone: 540-428-1715
  • Fax: 540-779-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110002297
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: