Provider Demographics
NPI:1790347714
Name:PRICE, JENNIFER E
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:PRICE
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 1:1716 W ABINGDON DR APT 303
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-1067
Mailing Address - Country:US
Mailing Address - Phone:828-475-9381
Mailing Address - Fax:
Practice Address - Street 1:1800 N BEAUREGARD ST STE 101
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1726
Practice Address - Country:US
Practice Address - Phone:828-475-9381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001255376163WG0000X
VA0024177887363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice