Provider Demographics
NPI:1588079735
Name:WOTHERSPOON, DARA COURTNEY (PA-C)
Entity type:Individual
Prefix:
First Name:DARA
Middle Name:COURTNEY
Last Name:WOTHERSPOON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9763 COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:SPOTSYLVANIA
Mailing Address - State:VA
Mailing Address - Zip Code:22553-1915
Mailing Address - Country:US
Mailing Address - Phone:540-786-1200
Mailing Address - Fax:540-786-3195
Practice Address - Street 1:9763 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:SPOTSYLVANIA
Practice Address - State:VA
Practice Address - Zip Code:22553-1915
Practice Address - Country:US
Practice Address - Phone:540-786-1200
Practice Address - Fax:540-786-3195
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-004625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant