Healthcare Provider Details

I. General information

NPI: 1376859637
Provider Name (Legal Business Name): PHYLLIS R. SYKES NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2010
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11814 KING WILLIAM RD
AYLETT VA
23009-4103
US

IV. Provider business mailing address

11814 KING WILLIAM RD PO BOX 213
AYLETT VA
23009-4103
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-3022
  • Fax: 804-769-1253
Mailing address:
  • Phone: 804-769-3022
  • Fax: 804-769-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168883
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: