Provider Demographics
NPI:1801923016
Name:STOVALL, VANESSA MILLER (PA)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:MILLER
Last Name:STOVALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:602 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-8970
Mailing Address - Country:US
Mailing Address - Phone:919-751-2828
Mailing Address - Fax:
Practice Address - Street 1:701 STEVENS MILL RD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530
Practice Address - Country:US
Practice Address - Phone:919-731-2023
Practice Address - Fax:919-731-2048
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0100646363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical