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General NPI Number Information
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NPI Number | 1225381437
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Entity Type | Individual
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Provider Name | JENNIFER L BAINUM CPNP, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 1577 WILROY RD STE 102
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City | SUFFOLK
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State | VA
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Zip | 23434-2433
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Country | US
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Telephone | 757-204-5775
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Fax | 757-257-2320
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Provider Business Mailing Address
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Address Line | 925 OLD HOMESTEAD LN
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4013
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Country | US
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Telephone | 619-417-0654
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Fax | 757-432-3269
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95011573
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024177886
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95011573
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024177886
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License Number State | VA
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