Provider Demographics
NPI:1982607248
Name:ADAMS, PATRICIA PORTER (CANP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:PORTER
Last Name:ADAMS
Suffix:
Gender:F
Credentials:CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8621 FORT HUNT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308
Mailing Address - Country:US
Mailing Address - Phone:703-257-3753
Mailing Address - Fax:703-360-3676
Practice Address - Street 1:8621 FORT HUNT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308
Practice Address - Country:US
Practice Address - Phone:703-257-3753
Practice Address - Fax:703-360-3676
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024108516363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982607248OtherPECOS
VAS62755Medicare UPIN