Basic Information
| Provider Information | |||||||||
| NPI: | 1659871580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4007 CLIFFORD ST | ||||||||
| Address2: | |||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 237072915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522072824 | ||||||||
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| Practice Location | |||||||||
| Address1: | 930 WEST 21ST STREET | ||||||||
| Address2: | STE 100 2ND FLOOR | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576228358 | ||||||||
| FaxNumber: | 7576229662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2018 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0024175790 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.