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General NPI Number Information
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NPI Number | 1558728386
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Entity Type | Individual
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Provider Name | MRS. JERRI CARR
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Gender | Female
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 09/24/2022
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Provider Practice Location Address
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Address Line | 14281 POTOMAC MILLS RD # 103
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City | WOODBRIDGE
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State | VA
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Zip | 22192-6805
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Country | US
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Telephone | 703-781-0188
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Fax |
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Provider Business Mailing Address
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Address Line | 5623 SPRIGGS MEADOW DR
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City | WOODBRIDGE
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State | VA
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Zip | 22193-6217
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Country | US
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Telephone | 703-781-0188
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Fax |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 0019009942
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1264001547
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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