Healthcare Provider Details

I. General information

NPI: 1992104673
Provider Name (Legal Business Name): MRS. JENNA PERKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA LEWIS

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 02/04/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 ORONOCO ST
ALEXANDRIA VA
22314-2015
US

IV. Provider business mailing address

7012 LAMP POST LN
ALEXANDRIA VA
22306-1325
US

V. Phone/Fax

Practice location:
  • Phone: 202-394-3849
  • Fax:
Mailing address:
  • Phone: 202-394-3849
  • Fax: 877-518-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN1034487
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number000-1294228
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: