Healthcare Provider Details

I. General information

NPI: 1285829697
Provider Name (Legal Business Name): JODY LYNN ROUPE R.N., M.S., A.C.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N GEORGE MASON DR CV CLINICIAN OFFICE 2ND FLOOR
ARLINGTON VA
22205-3683
US

IV. Provider business mailing address

4346 SHARMANS RUN
SHARPSBURG MD
21782-1938
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-6300
  • Fax:
Mailing address:
  • Phone: 301-730-0016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024164165
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: