Provider Demographics
NPI:1508345802
Name:REVARD, CARRIE JONES (LPN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:JONES
Last Name:REVARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7619 LITTLE RIVER TPKE STE 600
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2628
Mailing Address - Country:US
Mailing Address - Phone:703-752-8741
Mailing Address - Fax:703-752-8746
Practice Address - Street 1:7619 LITTLE RIVER TPKE STE 600
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2628
Practice Address - Country:US
Practice Address - Phone:703-752-8741
Practice Address - Fax:703-752-8746
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002031086164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse