Provider Demographics
NPI:1518919992
Name:SHEETS, JOE (PA)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:
Last Name:SHEETS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 SHEFFIELD DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-8271
Mailing Address - Country:US
Mailing Address - Phone:540-953-2210
Mailing Address - Fax:
Practice Address - Street 1:2617 SHEFFIELD DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-8271
Practice Address - Country:US
Practice Address - Phone:540-953-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV900363A00000X
VA0110002524363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3001610OtherBRICKSTREET
WV001836198OtherBLUE CROSS BLUE SHIELD
P00427090OtherRR MEDICARE
VA010275628Medicaid
P00427090OtherRR MEDICARE
VA010275628Medicaid