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NPI Code Detail

MEDICARE: MRS. MICHELLE LORENE BRYANT-ALBRIGHT PA-C

MEDICARE: MRS. MICHELLE LORENE BRYANT-ALBRIGHT PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician0110001220VA
2363A00000XPhysician Assistant0110001220VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10110001220OTHERVAPA LICENSE

General Provider Information

NPI Number : 1235142795
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LORENE BRYANT-ALBRIGHT PA-C
Provider Business Mailing Address
First Line : 4704 ASHBURG DR
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9230
Country : US
Telephone Number : 804-935-0405
Fax Number :
Provider Business Practice Location Address
First Line : 801 S ADAMS ST
Second Line :
City : PETERSBURG
State : VA
Zip : 23803-5149
Country : US
Telephone Number : 804-957-6106
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2006
Last Update Date : 01/06/2020

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