Healthcare Provider Details

I. General information

NPI: 1497559942
Provider Name (Legal Business Name): HOLLY LYNN MATTHEWS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17385 LANKFORD HWY
PARKSLEY VA
23421-3882
US

IV. Provider business mailing address

PO BOX 91
PARKSLEY VA
23421-0091
US

V. Phone/Fax

Practice location:
  • Phone: 757-665-5996
  • Fax: 757-665-5973
Mailing address:
  • Phone: 757-710-1437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024192571
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: