Jennifer R Tyson, NP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

0024190467 Issued in VA

Practice address

107 DMV Dr
Kilmarnock, VA 22482-3843

Phone

(804) 435-3103

Fax

(804) 435-6695

NPI assigned

Jun 28, 2024

Last updated

Jun 28, 2024By 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

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bay Internists, Inc.

  • Cardiovascular Disease Physician
  • Kilmarnock, VA
  • NPI 1306050661
  Medicare reassignment NPD

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

{
    "created_epoch": "1719532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1134964307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1599",
            "city": "KILMARNOCK",
            "state": "VA",
            "postal_code": "224821599",
            "telephone_number": "804-435-3103",
            "fax_number": "804-435-6695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 DMV DR",
            "city": "KILMARNOCK",
            "state": "VA",
            "postal_code": "224823843",
            "telephone_number": "804-435-3103",
            "fax_number": "804-435-6695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYSON",
        "first_name": "JENNIFER",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "VA",
            "license": "0024190467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Family Maternity Center of the Northern Neck, Inc. (Family Medical Clinic)
• The Family Maternity Center of the Northern Neck, Inc. (Family Medical Clinic)
• The Northern Neck-Middlesex Free Health Clinic, Inc.
• Kenneth L Thompson, RPH CGP
• Caroll Anne Throckmorton, RPH
• Vicki Lynne Vermeer, M.S.P.T.
• Vikas Maan MD, PLLC (Rappahannock Internal Medicine)
• Virginia CVS Pharmacy LLC (CVS Pharmacy #07557)
• Virginia Health Services, Inc (Lancashire Convalescent and Rehabilitation Center)
• Matthew Frederick Vogel, M.D.

• Gerontology Nurse Practitioner in Kilmarnock, VA
• Providers in Kilmarnock, VA by specialty
• Gerontology Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.