Healthcare Provider Details

I. General information

NPI: 1679405567
Provider Name (Legal Business Name): HEATHER JEFFERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44121 LEESBURG PIKE STE 275
ASHBURN VA
20147-5671
US

IV. Provider business mailing address

44121 LEESBURG PIKE STE 275
ASHBURN VA
20147-5671
US

V. Phone/Fax

Practice location:
  • Phone: 571-246-6704
  • Fax: 571-746-9040
Mailing address:
  • Phone: 571-246-6704
  • Fax: 571-746-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: