Provider Demographics
NPI:1205007465
Name:HUNNINGS, BLAKELY ANNE (PA)
Entity Type:Individual
Prefix:
First Name:BLAKELY
Middle Name:ANNE
Last Name:HUNNINGS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BLAKELY
Other - Middle Name:
Other - Last Name:HUNNINGS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:7858 SHRADER RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4222
Practice Address - Country:US
Practice Address - Phone:804-270-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001001283363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant