Healthcare Provider Details

I. General information

NPI: 1285652057
Provider Name (Legal Business Name): JAN L HUNDLEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1237 JEFFERSON ST
BOYDTON VA
23917
US

IV. Provider business mailing address

PO BOX 66
BOYDTON VA
23917
US

V. Phone/Fax

Practice location:
  • Phone: 434-738-0055
  • Fax: 434-738-0055
Mailing address:
  • Phone: 434-738-0055
  • Fax: 434-738-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000286
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number552
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: