Healthcare Provider Details

I. General information

NPI: 1144814831
Provider Name (Legal Business Name): JOSEPH JERVEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2021
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43228 SOMERSET HILLS TER
ASHBURN VA
20147-5247
US

IV. Provider business mailing address

43228 SOMERSET HILLS TER
ASHBURN VA
20147-5247
US

V. Phone/Fax

Practice location:
  • Phone: 434-710-0087
  • Fax:
Mailing address:
  • Phone: 434-710-0087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: