Provider Demographics
NPI:1467477273
Name:FOWLKES, VANESSA PEYTON (FNP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:PEYTON
Last Name:FOWLKES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2601
Mailing Address - Country:US
Mailing Address - Phone:804-254-1760
Mailing Address - Fax:401-235-6899
Practice Address - Street 1:201 N HAMILTON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2601
Practice Address - Country:US
Practice Address - Phone:804-254-1760
Practice Address - Fax:401-235-6899
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164743363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1467477273Medicaid
VA1467477273Medicaid
VAP00813496Medicare PIN