Provider Demographics
NPI:1134521271
Name:HOWELL, JENNIFER LEE (PA-C)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:HOWELL
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 1:1201 LAKE JAMES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6780
Mailing Address - Country:US
Mailing Address - Phone:757-523-0022
Mailing Address - Fax:
Practice Address - Street 1:1201 LAKE JAMES DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6780
Practice Address - Country:US
Practice Address - Phone:757-523-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-05910363AM0700X
VA0110007120363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMC3730644OtherDEA