MEDICARE: JEFFREY TRAVIS NEEDY APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	3007076	KY
2	363L00000X	Nurse Practitioner	0024177807	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000746201	OTHER	KY	ANTHEM
2	50034695	OTHER	KY	PASSPORT HEALTHPLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	311192100	OTHER	KY	BLACK LUNG/US DEPT OF LABOR
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306125570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY TRAVIS NEEDY APRN

Provider Business Mailing Address
First Line	:	1115 BOULDERS PKWY STE 200
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23225-4067
Country	:	US
Telephone Number	:	804-915-4607
Fax Number	:	804-560-9029

Provider Business Practice Location Address
First Line	:	8901 THREE CHOPT RD STE D
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229
Country	:	US
Telephone Number	:	804-440-4878
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2011
Last Update Date	:	10/20/2020

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Directions to “ JEFFREY TRAVIS NEEDY APRN” Practice Location

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