Provider Demographics
NPI:1508814245
Name:MELROSE-SMITH, JAYNE (CPNP)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:MELROSE-SMITH
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 ARLINGTON BLVD.
Mailing Address - Street 2:STE.210
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-534-1000
Mailing Address - Fax:703-536-7763
Practice Address - Street 1:6565 ARLINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:703-534-1000
Practice Address - Fax:703-536-7763
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024074953363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00789319Medicaid