Provider Demographics
NPI:1790867471
Name:BRIM, JESSICA LEE (NP)
Entity Type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LEE
Last Name:BRIM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5012
Mailing Address - Country:US
Mailing Address - Phone:540-404-9637
Mailing Address - Fax:540-404-4146
Practice Address - Street 1:610 S MARKET ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-5012
Practice Address - Country:US
Practice Address - Phone:540-404-9637
Practice Address - Fax:540-404-4146
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001235693163W00000X
VAAG0715012363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology