Provider Demographics
NPI:1861472458
Name:EVERETT, PHYLLIS COULTER (MSN AOCN AGN-BC NP-C)
Entity Type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:COULTER
Last Name:EVERETT
Suffix:
Gender:F
Credentials:MSN AOCN AGN-BC NP-C
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Mailing Address - Street 1:21430 TIMBERLAKE RD
Mailing Address - Street 2:PMB 318
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502
Mailing Address - Country:US
Mailing Address - Phone:540-297-6026
Mailing Address - Fax:540-297-6048
Practice Address - Street 1:10102 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:LYNCH STATION
Practice Address - State:VA
Practice Address - Zip Code:24571
Practice Address - Country:US
Practice Address - Phone:540-297-6026
Practice Address - Fax:540-297-6048
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-11-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166699363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861472458Medicaid