Basic Information
| Provider Information | |||||||||
| NPI: | 1053969188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHUMATE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6035 ELON RD | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245743162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349445839 | ||||||||
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| Practice Location | |||||||||
| Address1: | 134 ELON RD | ||||||||
| Address2: | |||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245722536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4344552480 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2019 | ||||||||
| LastUpdateDate: | 09/02/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 0024178160 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.