Provider Demographics
NPI:1427556315
Name:MCKENNA, VANESSA BARAJAS (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:BARAJAS
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MAPLE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2553
Mailing Address - Country:US
Mailing Address - Phone:804-288-7246
Mailing Address - Fax:804-288-7245
Practice Address - Street 1:1501 MAPLE AVE STE 300
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2553
Practice Address - Country:US
Practice Address - Phone:804-288-7246
Practice Address - Fax:804-288-7245
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175785363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty