Provider Demographics
NPI:1336116508
Name:FOXWORTHY HAGGARD, LINDA SUZANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUZANNE
Last Name:FOXWORTHY HAGGARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:SUZANNE
Other - Last Name:PURDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:FLOYD
Mailing Address - State:VA
Mailing Address - Zip Code:24091-0597
Mailing Address - Country:US
Mailing Address - Phone:540-745-6034
Mailing Address - Fax:540-745-6033
Practice Address - Street 1:274 FLOYD HWY S
Practice Address - Street 2:SUITE 102
Practice Address - City:FLOYD
Practice Address - State:VA
Practice Address - Zip Code:24091-2348
Practice Address - Country:US
Practice Address - Phone:540-745-6034
Practice Address - Fax:540-745-6033
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840358363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004658S79Medicare ID - Type UnspecifiedINDIVIDUAL NUMBER
VAQ17029Medicare UPIN