Healthcare Provider Details

I. General information

NPI: 1548701444
Provider Name (Legal Business Name): JENNIFER WALKER HENSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DRIVE SUITE 8630
VIRGINIA BEACH VA
23452
US

IV. Provider business mailing address

600 GRESHAM DRIVE SUITE 8630
VIRGINIA BEACH VA
23452
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6115
  • Fax:
Mailing address:
  • Phone: 757-388-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number0001201142
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174652
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: