Provider Demographics
NPI:1285693341
Name:HOAK, LEA PALMER (PMHCNS- BC)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:PALMER
Last Name:HOAK
Suffix:
Gender:F
Credentials:PMHCNS- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S BRADDOCK ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4043
Mailing Address - Country:US
Mailing Address - Phone:540-533-1187
Mailing Address - Fax:888-387-5457
Practice Address - Street 1:214 S BRADDOCK ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4043
Practice Address - Country:US
Practice Address - Phone:540-533-1187
Practice Address - Fax:888-387-5457
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000404364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA019133OtherANTHEM
VA010006597Medicaid
VA019133OtherANTHEM
VAP85137Medicare UPIN
VA001075W68Medicare PIN