Healthcare Provider Details

I. General information

NPI: 1003326315
Provider Name (Legal Business Name): ADAM JEFFREY ARNOLD FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25892 N JAMES MADISON HWY
NEW CANTON VA
23123-2234
US

IV. Provider business mailing address

1341 AUSTINS RD
GLADSTONE VA
24553-3624
US

V. Phone/Fax

Practice location:
  • Phone: 434-581-3271
  • Fax: 434-581-1105
Mailing address:
  • Phone: 434-262-2782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175131
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: