Provider Demographics
NPI:1396997151
Name:ST. ANA, VIRGINIA STOKES (CO, LO)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:STOKES
Last Name:ST. ANA
Suffix:
Gender:F
Credentials:CO, LO
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:CAROLYN
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CO, LO
Mailing Address - Street 1:2200 FORT ROOTS DR
Mailing Address - Street 2:BLDG 89 ROOM 101, PROSTHETIC TREATMENT CENTER
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72114-1709
Mailing Address - Country:US
Mailing Address - Phone:501-257-1600
Mailing Address - Fax:501-257-1624
Practice Address - Street 1:2200 FORT ROOTS DR
Practice Address - Street 2:BLDG 89 ROOM 101, PROSTHETIC TREATMENT CENTER
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72114-1709
Practice Address - Country:US
Practice Address - Phone:501-257-1600
Practice Address - Fax:501-257-1624
Is Sole Proprietor?:No
Enumeration Date:2008-10-10
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROPP00157222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO003046OtherAMERICAN BOARD FOR CERTIFIECATION IN ORTHOTICS AND PROSTHETICS, INC.
AROPP00157OtherARKANSAS STATE BOARD OF HEALTH