Provider Demographics
NPI:1295924538
Name:HAIRSTON, VANESSA PRICE (NP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:PRICE
Last Name:HAIRSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:KAYE
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 10399
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-5007
Mailing Address - Country:US
Mailing Address - Phone:434-685-7095
Mailing Address - Fax:434-685-2990
Practice Address - Street 1:4520 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:AXTON
Practice Address - State:VA
Practice Address - Zip Code:24054-2822
Practice Address - Country:US
Practice Address - Phone:434-685-7095
Practice Address - Fax:434-685-2990
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024097372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily