Healthcare Provider Details

I. General information

NPI: 1013996222
Provider Name (Legal Business Name): APRIL CHANNING LUST P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 12/08/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4868 BRIDGE RD STE 300
SUFFOLK VA
23435-2048
US

IV. Provider business mailing address

4868 BRIDGE RD STE 300
SUFFOLK VA
23435-2048
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-7100
  • Fax: 615-320-3259
Mailing address:
  • Phone: 757-483-7100
  • Fax: 615-320-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA885
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: