Provider Demographics
NPI:1104163021
Name:JUSTUS, PHYLLIS JEAN (APRN, FNP, MSN)
Entity type:Individual
Prefix:MRS
First Name:PHYLLIS
Middle Name:JEAN
Last Name:JUSTUS
Suffix:
Gender:F
Credentials:APRN, FNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 HORSEPOWER RD
Mailing Address - Street 2:
Mailing Address - City:GRUNDY
Mailing Address - State:VA
Mailing Address - Zip Code:24614-7439
Mailing Address - Country:US
Mailing Address - Phone:276-202-1546
Mailing Address - Fax:
Practice Address - Street 1:300 VALLEY ST NE
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2912
Practice Address - Country:US
Practice Address - Phone:276-206-8197
Practice Address - Fax:276-206-8716
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170560363LF0000X, 363LP2300X
VA00244170560208VP0000X
WV102626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care