Provider Demographics
NPI:1205890050
Name:JENNINGS, JENNIFER QUESINBERRY (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:QUESINBERRY
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIEFER
Other - Middle Name:Q
Other - Last Name:STIEFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1616 N MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4474
Mailing Address - Country:US
Mailing Address - Phone:276-783-8123
Mailing Address - Fax:276-783-1820
Practice Address - Street 1:1616 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4398
Practice Address - Country:US
Practice Address - Phone:276-783-8123
Practice Address - Fax:276-783-1820
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1513316OtherUMWA
VA080141171OtherRAILROAD MEDICARE
VA284383OtherANTHEM BCBS
VA30016061950001Medicaid
VA528863OtherSOUTHERN HEALTH
TNQ008400Medicaid
VA528863OtherSOUTHERN HEALTH
VAC09112Medicare UPIN
VA1205890050Medicaid
VA528863OtherSOUTHERN HEALTH
VA080141171OtherRAILROAD MEDICARE