Healthcare Provider Details

I. General information

NPI: 1770313322
Provider Name (Legal Business Name): JESSICA LYNN HARLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2024
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 REBECCA DR
PALMYRA VA
22963-6242
US

IV. Provider business mailing address

239 CARTER LN
LOUISA VA
23093-2657
US

V. Phone/Fax

Practice location:
  • Phone: 434-654-4680
  • Fax:
Mailing address:
  • Phone: 540-259-0868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190893
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: