Provider Demographics
NPI:1326651381
Name:LESSARD, JACKLYN MICHELLE JOLLY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:MICHELLE JOLLY
Last Name:LESSARD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACKLYN
Other - Middle Name:MICHELLE
Other - Last Name:JOLLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:3172 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1727
Mailing Address - Country:US
Mailing Address - Phone:703-475-9182
Mailing Address - Fax:
Practice Address - Street 1:6355 WALKER LN STE 401
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3250
Practice Address - Country:US
Practice Address - Phone:703-924-2100
Practice Address - Fax:703-922-6067
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner