MEDICARE: VANESSA PEYTON FOWLKES FNP

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
1	363LW0102X	Women's Health Nurse Practitioner	0024164743	VA
2	363LF0000X	Family Nurse Practitioner	0024164743	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467477273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA PEYTON FOWLKES FNP

Provider Business Mailing Address
First Line	:	201 N HAMILTON ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23221-2601
Country	:	US
Telephone Number	:	804-254-1760
Fax Number	:	401-235-6899

Provider Business Practice Location Address
First Line	:	5116 RICHMOND HENRICO TPKE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-3627
Country	:	US
Telephone Number	:	804-613-5907
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	06/13/2024

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