Healthcare Provider Details

I. General information

NPI: 1649083296
Provider Name (Legal Business Name): JESSICA VAN METER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 FRONT ROYAL PIKE
WINCHESTER VA
22602-4346
US

IV. Provider business mailing address

158 FRONT ROYAL PIKE
WINCHESTER VA
22602-4346
US

V. Phone/Fax

Practice location:
  • Phone: 667-220-0170
  • Fax:
Mailing address:
  • Phone: 667-220-0170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024192792
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: