MEDICARE: JESSICA R PITZER FNP

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	363LF0000X	Family Nurse Practitioner	102898	WV

General Provider Information

NPI Number	:	1386297364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA R PITZER FNP

Provider Business Mailing Address
First Line	:	PO BOX 590
Second Line	:
City	:	UNION
State	:	WV
Zip	:	24983-0590
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	226 MARKET ST
Second Line	:
City	:	NEW CASTLE
State	:	VA
Zip	:	24127-6080
Country	:	US
Telephone Number	:	540-864-6390
Fax Number	:

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

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	12/08/2020

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