Basic Information
| Provider Information | |||||||||
| NPI: | 1821575267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | STAUFFER | ||||||||
| FirstName: | JASMINE | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2215 LANDOVER PL | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349473944 | ||||||||
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| Practice Location | |||||||||
| Address1: | 582 BLUE RIDGE AVE | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245232604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404257910 | ||||||||
| FaxNumber: | 5405835149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2018 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0110006268 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.