1639652977 NPI number — JESSICA KEEFE ED.S

Table of content: JESSICA KEEFE ED.S (NPI 1639652977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639652977 NPI number — JESSICA KEEFE ED.S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEEFE
Provider First Name:
JESSICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ED.S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639652977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
642 CARRIAGE HILL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-263-2700
Provider Business Mailing Address Fax Number:
757-493-5437

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
642 CARRIAGE HILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-263-2700
Provider Business Practice Location Address Fax Number:
757-493-5437
Provider Enumeration Date:
09/12/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , with the licence number:  0813000292 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0813000292 . This is a "COMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".