Provider Demographics
NPI:1659591477
Name:REPPERT, BETTY R (PA)
Entity Type:Individual
Prefix:MRS
First Name:BETTY
Middle Name:R
Last Name:REPPERT
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 1:1300 W BROAD ST
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23284-9089
Mailing Address - Country:US
Mailing Address - Phone:804-828-7816
Mailing Address - Fax:
Practice Address - Street 1:1300 W BROAD ST
Practice Address - Street 2:SUITE 2200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23284-9089
Practice Address - Country:US
Practice Address - Phone:804-828-7816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110000136363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant