Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 24162394 | VA |
NPI | 1023003266 |
---|---|
Provider Name | Matthew J Sykes |
First Address | Abingdon, VA 24212-0807 |
Second Address | Abingdon, VA 24210-0807 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 11/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P30941 | (02) | VA |