Healthcare Provider Details

I. General information

NPI: 1225692973
Provider Name (Legal Business Name): JESSICA PATTERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2019
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 365
SPRINGFIELD VA
22150-2526
US

IV. Provider business mailing address

PO BOX 40412
BELFAST ME
04915-1255
US

V. Phone/Fax

Practice location:
  • Phone: 571-642-3433
  • Fax:
Mailing address:
  • Phone: 248-824-6032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024177543
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: