Provider Demographics
NPI:1538696604
Name:MEYERS, JESSICA NICHOLE (CRNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICHOLE
Last Name:MEYERS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 THAYER CTR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1138
Mailing Address - Country:US
Mailing Address - Phone:301-859-7178
Mailing Address - Fax:240-270-5229
Practice Address - Street 1:4000 THAYER CTR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1138
Practice Address - Country:US
Practice Address - Phone:301-859-7178
Practice Address - Fax:240-270-5229
Is Sole Proprietor?:No
Enumeration Date:2017-05-18
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR189447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily