Healthcare Provider Details

I. General information

NPI: 1861809410
Provider Name (Legal Business Name): JESSICA FAYE RASNICK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 06/16/2023
Certification Date: 06/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 LOVERS GAP RD
VANSANT VA
24656-9781
US

IV. Provider business mailing address

1721 LOVERS GAP RD
VANSANT VA
24656-9781
US

V. Phone/Fax

Practice location:
  • Phone: 276-597-7081
  • Fax: 276-546-9709
Mailing address:
  • Phone: 276-597-7081
  • Fax: 276-546-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024171729
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: