Provider Demographics
NPI:1952701336
Name:COAKE, VENESSA A (FNP-C)
Entity Type:Individual
Prefix:
First Name:VENESSA
Middle Name:A
Last Name:COAKE
Suffix:
Gender:F
Credentials:FNP-C
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 9
Mailing Address - Street 2:
Mailing Address - City:LAUREL FORK
Mailing Address - State:VA
Mailing Address - Zip Code:24352-0009
Mailing Address - Country:US
Mailing Address - Phone:276-398-1200
Mailing Address - Fax:276-398-2094
Practice Address - Street 1:14558 DANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LAUREL FORK
Practice Address - State:VA
Practice Address - Zip Code:24352-3982
Practice Address - Country:US
Practice Address - Phone:276-398-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA139063163W00000X
VA0024172413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1952701336Medicaid