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General NPI Number Information
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NPI Number | 1144004268
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Entity Type | Individual
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Provider Name | BROOKE LYNN MATTOX
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Gender | Female
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 09/29/2025
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Provider Practice Location Address
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Address Line | 2410 ATHERHOLT RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-2148
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Country | US
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Telephone | 434-200-5252
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Fax |
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Provider Business Mailing Address
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Address Line | 316 PROSPECT RD
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City | HURT
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State | VA
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Zip | 24563-2120
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Country | US
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Telephone | 951-207-3750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110009749
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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