Provider Demographics
NPI:1821327024
Name:REILLY, JENNIFER CONNELLY (WHNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CONNELLY
Last Name:REILLY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 NARVIK CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-6611
Mailing Address - Country:US
Mailing Address - Phone:804-364-7293
Mailing Address - Fax:
Practice Address - Street 1:5875 BREMO RD STE 701
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1928
Practice Address - Country:US
Practice Address - Phone:804-523-2533
Practice Address - Fax:804-523-2534
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168547363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVP882AMedicaid