Provider Demographics
NPI:1497994578
Name:PUMPHREY, LATOYA DENISE (PA)
Entity Type:Individual
Prefix:MISS
First Name:LATOYA
Middle Name:DENISE
Last Name:PUMPHREY
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 1:1035 CHAMPIONS WAY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3762
Mailing Address - Country:US
Mailing Address - Phone:757-394-1390
Mailing Address - Fax:757-394-1393
Practice Address - Street 1:1035 CHAMPIONS WAY
Practice Address - Street 2:SUITE 600
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3762
Practice Address - Country:US
Practice Address - Phone:757-394-1390
Practice Address - Fax:757-394-1393
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002955363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical