Provider Demographics
NPI:1003090945
Name:PRITCHETT, MICHELLE DENISE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:DENISE
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DANIELLE
Other - Middle Name:RENEE
Other - Last Name:PRITCHETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8985 AL PHILPOTT HWY
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112-1967
Mailing Address - Country:US
Mailing Address - Phone:276-666-2227
Mailing Address - Fax:276-666-2228
Practice Address - Street 1:538 STONEY MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-1149
Practice Address - Country:US
Practice Address - Phone:276-666-2227
Practice Address - Fax:276-666-2228
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6423172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver