Provider Demographics
NPI:1477643864
Name:WILLOUGHBY-NUNLEY, RHONDA L (PA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:WILLOUGHBY-NUNLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:
Practice Address - Street 1:127 MCCLANAHAN STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014
Practice Address - Country:US
Practice Address - Phone:540-982-8204
Practice Address - Fax:540-527-1039
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001222207RC0000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008937974Medicaid
VA970000441Medicare ID - Type Unspecified
VA008937974Medicaid