Provider Demographics
NPI:1568650802
Name:WHITFIELD, VIVIA BROGDEN (FNP)
Entity Type:Individual
Prefix:
First Name:VIVIA
Middle Name:BROGDEN
Last Name:WHITFIELD
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 1:115 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23927-9125
Mailing Address - Country:US
Mailing Address - Phone:434-374-5344
Mailing Address - Fax:434-374-4814
Practice Address - Street 1:115 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23927-9125
Practice Address - Country:US
Practice Address - Phone:434-374-5344
Practice Address - Fax:434-374-4814
Is Sole Proprietor?:No
Enumeration Date:2007-10-11
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167548363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568650802Medicaid
VA1568650802Medicaid