Basic Information
| Provider Information | |||||||||
| NPI: | 1205890050 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENNINGS | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | QUESINBERRY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STIEFEL | ||||||||
| OtherFirstName: | JENNIEFER | ||||||||
| OtherMiddleName: | Q | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1616 N MAIN ST STE C | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767838123 | ||||||||
| FaxNumber: | 2767831820 | ||||||||
| Practice Location | |||||||||
| Address1: | 1616 N MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544398 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767838123 | ||||||||
| FaxNumber: | 2767831820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 06/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101058540 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1513316 | 01 | VA | UMWA | OTHER | 528863 | 01 | VA | SOUTHERN HEALTH | OTHER | 080141171 | 01 | VA | RAILROAD MEDICARE | OTHER | Q008400 | 05 | TN | MEDICAID | 284383 | 01 | VA | ANTHEM BCBS | OTHER |