Jacelyn Norris, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110002333 Issued in VA

Practice address

22895 Brambleton PLZ
Suite 200
Brambleton, VA 20148-4876

Phone

(703) 327-3173

Fax

(703) 740-8317

NPI assigned

Nov 6, 2006

Last updated

May 7, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336348800000",
    "number": "1003995200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 LINDEN DR",
            "address_2": "SUITE 154",
            "city": "WINCHESTER",
            "state": "VA",
            "postal_code": "226012894",
            "telephone_number": "540-535-0777",
            "fax_number": "703-740-8317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22895 BRAMBLETON PLZ",
            "address_2": "SUITE 200",
            "city": "BRAMBLETON",
            "state": "VA",
            "postal_code": "201484876",
            "telephone_number": "703-327-3173",
            "fax_number": "703-740-8317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORRIS",
        "first_name": "JACELYN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-06",
        "last_updated": "2012-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003995200",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00667931",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Brambleton, VA
• Providers in Brambleton, VA by specialty
• Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.