Provider Demographics
NPI:1336355189
Name:JEWELL, CAROLYN E (RN, PMHNP)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:E
Last Name:JEWELL
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17163 KATY LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERDAM
Mailing Address - State:VA
Mailing Address - Zip Code:23015-1785
Mailing Address - Country:US
Mailing Address - Phone:804-449-1591
Mailing Address - Fax:
Practice Address - Street 1:1200 E BROAD ST
Practice Address - Street 2:WEST HOSPITAL, 11TH FLOOR
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5058
Practice Address - Country:US
Practice Address - Phone:804-828-9915
Practice Address - Fax:804-828-9906
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165546363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health