Provider Demographics
NPI:1508157272
Name:ROSS, JENNIFER BELL (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BELL
Last Name:ROSS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10085 WILLIAM F BERNART CIRCLE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413-0979
Practice Address - Country:US
Practice Address - Phone:757-414-8355
Practice Address - Fax:757-414-8016
Is Sole Proprietor?:No
Enumeration Date:2011-04-28
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024169359363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV1772BMedicare PIN
VA1508157272Medicaid
VAP01064373Medicare PIN