Provider Demographics
NPI:1235373754
Name:OSBORNE-RODDENBERRY, JENNIFER NICHOLE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:OSBORNE-RODDENBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:NICHOLE
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:50 SCHENCK PKWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3499
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 CHOCTAW ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4513
Practice Address - Country:US
Practice Address - Phone:828-255-7733
Practice Address - Fax:828-258-3084
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-02415207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1235373754Medicaid
WVP01520195OtherRAILROAD
WVWV5599D046Medicare PIN
WV003188277OtherBCBS ID