Healthcare Provider Details

I. General information

NPI: 1679592554
Provider Name (Legal Business Name): JOY K CREED FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 CARROLL DRIVE
FRIES VA
24330-4532
US

IV. Provider business mailing address

14558 DANVILLE PIKE
LAUREL FORK VA
24352-3982
US

V. Phone/Fax

Practice location:
  • Phone: 888-908-4788
  • Fax: 276-398-2094
Mailing address:
  • Phone: 276-398-1200
  • Fax: 276-398-2094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024165309
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: