Healthcare Provider Details

I. General information

NPI: 1003543984
Provider Name (Legal Business Name): JESSY A NWUBA DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2022
Last Update Date: 04/01/2023
Certification Date: 04/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 BOULEVARD
COLONIAL HEIGHTS VA
23834-1344
US

IV. Provider business mailing address

3611 BOULEVARD
COLONIAL HEIGHTS VA
23834-1344
US

V. Phone/Fax

Practice location:
  • Phone: 571-523-5479
  • Fax: 804-374-8889
Mailing address:
  • Phone: 571-523-5479
  • Fax: 804-374-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number350991
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2376097
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAC004987
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024184767
License Number StateVA
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024184767
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: