Healthcare Provider Details

I. General information

NPI: 1598450678
Provider Name (Legal Business Name): JESSICA MARIE JEMISON NP, RN, LVT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7864 RICHMOND TAPPAHANNOCK HWY
AYLETT VA
23009-3056
US

IV. Provider business mailing address

7443 LEE DAVIS RD
MECHANICSVILLE VA
23111-4484
US

V. Phone/Fax

Practice location:
  • Phone: 804-769-2015
  • Fax:
Mailing address:
  • Phone: 803-238-9910
  • Fax: 866-403-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001304447
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024192201
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: