Provider Demographics
NPI:1942766035
Name:SPINKS, GRACE VICTORIA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:VICTORIA
Last Name:SPINKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:VICTORIA
Other - Last Name:HIXSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13060 ELM TREE DR APT 401
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-4871
Mailing Address - Country:US
Mailing Address - Phone:214-914-6696
Mailing Address - Fax:
Practice Address - Street 1:110 IRVING ST NW # 4B42
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:214-914-6696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-14
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 390200000X
DCPA031739363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program