MEDICARE: STEPHANIE NICOLE JARVIS CRNP

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	AC000969	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841567856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE NICOLE JARVIS CRNP

Provider Business Mailing Address
First Line	:	109 RAYLOC DR
Second Line	:
City	:	HANCOCK
State	:	MD
Zip	:	21750-1518
Country	:	US
Telephone Number	:	301-678-5187
Fax Number	:	301-678-5797

Provider Business Practice Location Address
First Line	:	261 BERKMORE PL STE 1A
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-6247
Country	:	US
Telephone Number	:	304-258-5790
Fax Number	:	304-258-3745

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

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	02/25/2019

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