Healthcare Provider Details

I. General information

NPI: 1952172819
Provider Name (Legal Business Name): BLUE RIDGE WOUND CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2024
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 COLONIAL AVE SW
ROANOKE VA
24015-3121
US

IV. Provider business mailing address

2522 COLONIAL AVE SW
ROANOKE VA
24015-3121
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-0055
  • Fax: 540-627-5055
Mailing address:
  • Phone: 540-343-0055
  • Fax: 540-627-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ELIZABETH WALKER
Title or Position: CEO
Credential: DC
Phone: 540-343-0055