Provider Demographics
NPI:1700512589
Name:JAINDL, JESSICA R (FNP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:R
Last Name:JAINDL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:JAINDL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:120 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT JACKSON
Mailing Address - State:VA
Mailing Address - Zip Code:22842-9417
Mailing Address - Country:US
Mailing Address - Phone:405-477-3185
Mailing Address - Fax:
Practice Address - Street 1:120 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:MOUNT JACKSON
Practice Address - State:VA
Practice Address - Zip Code:22842-9417
Practice Address - Country:US
Practice Address - Phone:405-477-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily