Provider Demographics
NPI:1053418384
Name:MCINNIS, ALLISON S (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:S
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:4630 S LABURNUM AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2424
Mailing Address - Country:US
Mailing Address - Phone:804-222-5511
Mailing Address - Fax:804-222-7041
Practice Address - Street 1:1850 POCAHONTAS TRAIL
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-0007
Practice Address - Country:US
Practice Address - Phone:804-932-4388
Practice Address - Fax:804-932-9860
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
VA0110002145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541486119OtherTAX ID NUMBER
VA541486119OtherTAX ID NUMBER