Provider Demographics
NPI:1720811003
Name:WINSTON, JAMES LAVON (FNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LAVON
Last Name:WINSTON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 SPARKLEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8000
Mailing Address - Country:US
Mailing Address - Phone:804-441-5802
Mailing Address - Fax:
Practice Address - Street 1:321 POPLAR DR STE C
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9391
Practice Address - Country:US
Practice Address - Phone:804-733-5591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190943363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty