Healthcare Provider Details

I. General information

NPI: 1396640488
Provider Name (Legal Business Name): NICOLE JONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAPLE AVE STE 305
RICHMOND VA
23226-2553
US

IV. Provider business mailing address

8609 DIVER CT
BRISTOW VA
20136-2063
US

V. Phone/Fax

Practice location:
  • Phone: 703-946-9805
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001334914
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: