Provider Demographics
NPI:1659623478
Name:CAMPBELL, JESSICA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S GEORGE MASON DR STE 107
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1676
Mailing Address - Country:US
Mailing Address - Phone:703-717-7313
Mailing Address - Fax:703-717-7314
Practice Address - Street 1:950 S GEORGE MASON DR STE 107
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1676
Practice Address - Country:US
Practice Address - Phone:703-717-7313
Practice Address - Fax:703-717-7314
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR208387363LW0102X
NY421099363LW0102X
VA0024171148363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health