Provider Demographics
NPI:1326462805
Name:FARMER, DANIEL
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:FARMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 CAMPUS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-9700
Mailing Address - Country:US
Mailing Address - Phone:276-739-8010
Mailing Address - Fax:276-628-1410
Practice Address - Street 1:603 CAMPUS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-9700
Practice Address - Country:US
Practice Address - Phone:276-739-8010
Practice Address - Fax:276-628-1410
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326462805Medicaid
TNQ008369Medicaid
VA1326462805Medicaid
TNQ008369Medicaid
VAVVC917CMedicare PIN