Healthcare Provider Details

I. General information

NPI: 1508258013
Provider Name (Legal Business Name): MARY COURTNEY CAPSTACK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2015
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1871 EVELYN BYRD AVE
HARRISONBURG VA
22801-3487
US

IV. Provider business mailing address

1871 EVELYN BYRD AVE
HARRISONBURG VA
22801-3487
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-5800
  • Fax:
Mailing address:
  • Phone: 540-564-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110004868
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: