Provider Demographics
NPI:1699495168
Name:PANNELL, NAKISHA NICOLE
Entity type:Individual
Prefix:
First Name:NAKISHA
Middle Name:NICOLE
Last Name:PANNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MURRAY PL
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-5004
Mailing Address - Country:US
Mailing Address - Phone:434-439-3283
Mailing Address - Fax:434-818-0943
Practice Address - Street 1:4000 MURRAY PL
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-5004
Practice Address - Country:US
Practice Address - Phone:434-439-3283
Practice Address - Fax:434-818-0943
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002096536164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse