Healthcare Provider Details

I. General information

NPI: 1457355299
Provider Name (Legal Business Name): JACQUELINE L WEBB PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14558 DANVILLE PIKE
LAUREL FORK VA
24352-3982
US

IV. Provider business mailing address

PO BOX 9
LAUREL FORK VA
24352-0009
US

V. Phone/Fax

Practice location:
  • Phone: 276-398-2292
  • Fax: 273-398-3331
Mailing address:
  • Phone: 276-398-1200
  • Fax: 273-398-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024134336
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: