Healthcare Provider Details

I. General information

NPI: 1861472458
Provider Name (Legal Business Name): PHYLLIS COULTER EVERETT MSN AOCN AGN-BC NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10961 LEE JACKSON HWY
BIG ISLAND VA
24526
US

IV. Provider business mailing address

21430 TIMBERLAKE RD PMB 318
LYNCHBURG VA
24502
US

V. Phone/Fax

Practice location:
  • Phone: 434-299-5029
  • Fax:
Mailing address:
  • Phone: 540-297-6026
  • Fax: 540-297-6048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024166699
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: