MEDICARE: JANE CLAIR MCKENNA

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	363LA2100X	Acute Care Nurse Practitioner	AP139613	TX
2	363LA2100X	Acute Care Nurse Practitioner	0024187051	VA

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	:	1902374853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE CLAIR MCKENNA

Provider Business Mailing Address
First Line	:	3975 FAIR RIDGE DR # 125
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2911
Country	:	US
Telephone Number	:	32-598-4237
Fax Number	:

Provider Business Practice Location Address
First Line	:	3975 FAIR RIDGE DR # 125
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-2911
Country	:	US
Telephone Number	:	703-259-8423
Fax Number	:

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

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	02/06/2025

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Directions to “ JANE CLAIR MCKENNA ” Practice Location

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