Healthcare Provider Details

I. General information

NPI: 1699643874
Provider Name (Legal Business Name): JENNIFER RENAE MOSIER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1583 N MAIN ST
MARION VA
24354-4317
US

IV. Provider business mailing address

1583 N MAIN ST
MARION VA
24354-4317
US

V. Phone/Fax

Practice location:
  • Phone: 276-247-9669
  • Fax: 276-243-0057
Mailing address:
  • Phone: 276-247-9669
  • Fax: 276-243-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024197006
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: