Basic Information
| Provider Information | |||||||||
| NPI: | 1376566554 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEACHEY | ||||||||
| FirstName: | BRIONY | ||||||||
| MiddleName: | JAINE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7500 IRON BAR LN | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201553603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037536772 | ||||||||
| FaxNumber: | 8889724515 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 IRON BAR LN | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037536772 | ||||||||
| FaxNumber: | 8889724515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0001161128 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 010201667 | 05 | VA | MEDICAID |