Provider Demographics
NPI:1235142795
Name:BRYANT-ALBRIGHT, MICHELLE LORENE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LORENE
Last Name:BRYANT-ALBRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 ASHBURG DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9230
Mailing Address - Country:US
Mailing Address - Phone:804-935-0405
Mailing Address - Fax:
Practice Address - Street 1:801 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5149
Practice Address - Country:US
Practice Address - Phone:804-957-6106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001220207P00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0110001220OtherPA LICENSE
VA0110001220OtherPA LICENSE
VAVAA1036047Medicare PIN
VA020255V20Medicare PIN
VA020257V21Medicare PIN
VAVAA103605Medicare PIN
VAVAA103606Medicare PIN
VA020254V01Medicare PIN