Provider Demographics
NPI:1023234226
Name:MCCURLEY, JENNIFER S (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:MCCURLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1971 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 1895
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24515-0002
Mailing Address - Country:US
Mailing Address - Phone:434-338-7774
Mailing Address - Fax:434-338-7773
Practice Address - Street 1:1971 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 1895
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24515-0002
Practice Address - Country:US
Practice Address - Phone:434-338-7774
Practice Address - Fax:434-338-7773
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01100016863363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972680049OtherCVFP SITE NPI
1528155892OtherCVFP CORPORATE NPI
021737C58 - CVFPMedicare PIN