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General NPI Number Information
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NPI Number | 1659855773
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Entity Type | Individual
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Provider Name | JESSICA WHEATLEY CRNP
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Gender | Female
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 07/27/2025
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Provider Practice Location Address
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Address Line | 400 E PRATT ST STE 800
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City | BALTIMORE
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State | MD
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Zip | 21202-3122
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Country | US
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Telephone | 855-403-0967
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Fax |
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Provider Business Mailing Address
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Address Line | 7809 WISCONSIN AVE
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City | BETHESDA
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State | MD
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Zip | 20814-3523
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R209739
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License Number State | MD
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