Healthcare Provider Details

I. General information

NPI: 1730043506
Provider Name (Legal Business Name): FIVE STAR HOUSE CALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14420 ALBEMARLE POINT PL STE 150
CHANTILLY VA
20151-1690
US

IV. Provider business mailing address

14420 ALBEMARLE POINT PL STE 150
CHANTILLY VA
20151-1690
US

V. Phone/Fax

Practice location:
  • Phone: 703-436-0150
  • Fax:
Mailing address:
  • Phone: 703-436-0150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOHNNY WILKINSON
Title or Position: CEO
Credential:
Phone: 703-436-0150