Provider Demographics
NPI:1548521800
Name:ANDERSON, JENNIFER LYNN (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:ANDERSON
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 1:124 VALLEY VISTA DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22664-1608
Mailing Address - Country:US
Mailing Address - Phone:540-459-1700
Mailing Address - Fax:540-459-1809
Practice Address - Street 1:124 VALLEY VISTA DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1608
Practice Address - Country:US
Practice Address - Phone:540-459-1700
Practice Address - Fax:540-459-1809
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52023363LF0000X
VA0024171039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily