Basic Information
| Provider Information | |||||||||
| NPI: | 1730485384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WRITSEL | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8310 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240140310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403453556 | ||||||||
| FaxNumber: | 5403422193 | ||||||||
| Practice Location | |||||||||
| Address1: | 2006 HEALTH CAMPUS DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | ROCKINGHAM | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228018679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406895900 | ||||||||
| FaxNumber: | 5406895602 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2011 | ||||||||
| LastUpdateDate: | 02/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | TL1887 | SC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | 0010-05938 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | 0110003522 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1107588 | 01 | SC | WELLCARE | OTHER | 80023057 | 01 | SC | SELECT HEALTH | OTHER | 8103200 | 05 | NC | MEDICAID | 3578543 | 01 | SC | UNITED HEALTHCARE | OTHER | 80023060 | 01 | SC | SELECT HEALTH | OTHER | P01155934 | 01 | SC | RAILROAD MCR | OTHER |