Healthcare Provider Details

I. General information

NPI: 1548984685
Provider Name (Legal Business Name): MADYLYN AUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7205 LITTLE RIVER TPKE
ANNANDALE VA
22003-3304
US

IV. Provider business mailing address

7205 LITTLE RIVER TPKE
ANNANDALE VA
22003-3304
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185840
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number0001281987
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN1050184
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: