Provider Demographics
NPI:1841637089
Name:HADLEY, STEPHANIE MARGARET (PA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARGARET
Last Name:HADLEY
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:PO BOX 100 DEPT#394
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:941-300-4440
Mailing Address - Fax:941-404-1760
Practice Address - Street 1:1001 MONTICELLO AVE # 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2564
Practice Address - Country:US
Practice Address - Phone:757-346-5770
Practice Address - Fax:866-292-0928
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004176363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10111596AOtherOPTIMA HEALTH
VA-032OtherTRICARE/CHAMPUS
NC1841637089Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL
VAPAROtherMULTIPLAN
VA1841637089Medicaid
VAPAROtherUSA MANAGED CARE