Provider Demographics
NPI:1013996222
Name:LUST, APRIL CHANNING (PA)
Entity type:Individual
Prefix:MISS
First Name:APRIL
Middle Name:CHANNING
Last Name:LUST
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:4868 BRIDGE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-2048
Mailing Address - Country:US
Mailing Address - Phone:757-483-7100
Mailing Address - Fax:615-320-3259
Practice Address - Street 1:4868 BRIDGE RD STE 300
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-2048
Practice Address - Country:US
Practice Address - Phone:757-483-7100
Practice Address - Fax:615-320-3259
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2023-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNPA885363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ001867Medicaid
TNQ001867Medicaid
TN103I971406Medicare PIN