Provider Demographics
NPI:1730485384
Name:WRITSEL, JENNIFER MICHELE (PA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MICHELE
Last Name:WRITSEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0310
Mailing Address - Country:US
Mailing Address - Phone:540-345-3556
Mailing Address - Fax:540-342-2193
Practice Address - Street 1:740 S LIMESTONE STE B200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-8679
Practice Address - Country:US
Practice Address - Phone:859-257-3533
Practice Address - Fax:859-218-7693
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003522363A00000X
KYPA3589363AM0700X, 363AS0400X, 363A00000X
NC0010-05938363AS0400X
SCTL1887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1107588OtherWELLCARE
SC80023060OtherSELECT HEALTH
SC80023057OtherSELECT HEALTH
NC8103200Medicaid
SC3578543OtherUNITED HEALTHCARE
SCP01155934OtherRAILROAD MCR
SC1107588OtherWELLCARE