Doctor Name: | JESSICA KENTY |
NPI Number: | 1750736757 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 0024173376 |
Business Practice Address: | 140 Stoneridge Dr S Suite 100 Ruckersville, VA - 229683096 |
Business Phone Number: | 4349852891 |
Business Fax Number: | 4349857848 |
Mailing Address: | Po Box 75268, BALTIMORE |
State: | MD |
Postal Code: | 212755268 |
Phone Number: | 4346547794 |
Fax Number: | 4346547752 |
NPI Enumeration Date: | 04/27/2016 |
NPI Last Update Date: | 05/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024173376 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |