Providence Medical LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

PROVIDENCE MEDICAL LLC

Practice address

150 Riverside Pkwy Ste 115 PMB 5560
Fredericksburg, VA 22406-1094

Phone

(347) 571-1312

NPI assigned

Jan 8, 2026

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew DaughertyNPI 1366078784

Title

Ceo

Phone

(347) 571-1312

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Daugherty, FNP

  • Family Nurse Practitioner
  • Fredericksburg, VA
  • NPI 1366078784

  Family, VA

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1767830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768348800000",
    "number": "1831056191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 RIVERSIDE PKWY STE 115",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224061094",
            "telephone_number": "347-571-1312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 RIVERSIDE PKWY STE 115 PMB 5560",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224061094",
            "telephone_number": "347-571-1312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-08",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "status": "A",
        "authorized_official_last_name": "DAUGHERTY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "347-571-1312"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in Fredericksburg, VA
• Providers in Fredericksburg, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.