Provider Demographics
NPI:1043611882
Name:THURSTON, VIRGINIA A (NP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:THURSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 CAMPUS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9703
Mailing Address - Country:US
Mailing Address - Phone:276-628-1186
Mailing Address - Fax:276-628-8507
Practice Address - Street 1:613 CAMPUS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9703
Practice Address - Country:US
Practice Address - Phone:276-628-1186
Practice Address - Fax:276-628-8507
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18819363LF0000X
VA0024171725363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009510Medicaid
VAP01440792OtherRAILROAD MEDICARE
VA1043611882Medicaid
VA1043611882Medicaid
VAVVF147BMedicare PIN
TNQ009510Medicaid