Provider Demographics
NPI:1366118648
Name:KOONTZ, SKYLER RISTON (FNP)
Entity type:Individual
Prefix:MS
First Name:SKYLER
Middle Name:RISTON
Last Name:KOONTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1165 SUNSET AVENUE EXT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-7861
Mailing Address - Country:US
Mailing Address - Phone:540-937-0385
Mailing Address - Fax:
Practice Address - Street 1:260 PANTOPS CTR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8601
Practice Address - Country:US
Practice Address - Phone:434-244-3027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily