Healthcare Provider Details

I. General information

NPI: 1962138560
Provider Name (Legal Business Name): VELMA JEAN SYKES-NIBLETT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/23/2024
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 VALLEY VIEW LN
DALLAS TX
75244-5074
US

IV. Provider business mailing address

169 DANIEL RD
AXTON VA
24054-2076
US

V. Phone/Fax

Practice location:
  • Phone: 779-770-4243
  • Fax:
Mailing address:
  • Phone: 276-340-1521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024183346
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: