Provider Demographics
NPI:1265504567
Name:BROWN, HEATHER N (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:N
Last Name:BROWN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2219
Mailing Address - Country:US
Mailing Address - Phone:804-249-8888
Mailing Address - Fax:804-249-7246
Practice Address - Street 1:5901 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2219
Practice Address - Country:US
Practice Address - Phone:804-249-8888
Practice Address - Fax:804-249-7246
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001417363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAMB1066465OtherDEA
VA00X030F01Medicare ID - Type Unspecified
VAMB1066465OtherDEA