Basic Information
Provider Information | |||||||||
NPI: | 1699790576 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SYKES | ||||||||
FirstName: | AMBER | ||||||||
MiddleName: | REYNOLDS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | P.A. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1115 BOULDERS PKWY | ||||||||
Address2: | SUITE 200 | ||||||||
City: | NORTH CHESTERFIELD | ||||||||
State: | VA | ||||||||
PostalCode: | 232254067 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8045605595 | ||||||||
FaxNumber: | 8045609029 | ||||||||
Practice Location | |||||||||
Address1: | 13700 ST FRANCIS BLVD | ||||||||
Address2: | SUITE 103 | ||||||||
City: | MIDLOTHIAN | ||||||||
State: | VA | ||||||||
PostalCode: | 231143222 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8043792414 | ||||||||
FaxNumber: | 8043792413 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/13/2006 | ||||||||
LastUpdateDate: | 10/21/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/21/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | 0110002330 | VA | N |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 0110002330 | VA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |   |
ID Information
ID | Type | State | Issuer | Description | 2366163 | 01 | VA | AETNA HMO | OTHER | 540885859 | 01 | VA | FIRST HEALTH | OTHER | 010323789 | 05 | VA |   | MEDICAID | 540885859 | 01 | VA | MULTIPLAN | OTHER | 140041 | 01 | VA | ANTHEM | OTHER | 540885859 | 01 | VA | FOCUS | OTHER | 289325 | 01 | VA | SOUTHERN HEALTH | OTHER | 10012041P | 01 | VA | OPTIMA HEALTH | OTHER | 540885859 | 01 | VA | CIGNA | OTHER | 2138218 | 01 | VA | UNITED HEALTHCARE | OTHER |