Healthcare Provider Details

I. General information

NPI: 1194524983
Provider Name (Legal Business Name): MOLLY KATHERINE SUTHERLAND FNP-C, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 COMFORT WAY STE 1
LEXINGTON VA
24450-3788
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-463-3381
  • Fax: 540-463-3477
Mailing address:
  • Phone: 540-332-5168
  • Fax: 540-332-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024191944
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: