Healthcare Provider Details

I. General information

NPI: 1982368882
Provider Name (Legal Business Name): JADE L CARDEN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS JADE TIARRA LAYELL

II. Dates (important events)

Enumeration Date: 10/26/2021
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W MAIN ST
CHARLOTTESVILLE VA
22903-2824
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-1906
  • Fax:
Mailing address:
  • Phone: 434-295-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024182830
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: