Provider Demographics
NPI:1548457815
Name:JENNINGS, LAILA Q (NP)
Entity type:Individual
Prefix:
First Name:LAILA
Middle Name:Q
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-594-2195
Practice Address - Street 1:16 DELFAE DR
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:VA
Practice Address - Zip Code:22572-4281
Practice Address - Country:US
Practice Address - Phone:804-333-6400
Practice Address - Fax:804-333-3796
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2011-05-11
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Provider Licenses
StateLicense IDTaxonomies
VA0024165756363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548457815Medicaid
VA1548457815Medicaid
VAVAA102487Medicare PIN