Individual provider Active NPI

Jamie Lynn Holder

  • Psychiatric/Mental Health Nurse Practitioner
  • Fredericksburg, VA
National Provider Identifier
1447905856
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
0024183705 Issued in VA
Practice address
621 Jefferson Davis Hwy Ste 201
Fredericksburg, VA 22401-4567
Phone
(540) 372-2028
NPI assigned
Feb 14, 2022
Last updated
Feb 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 0024183705 VA Primary

Addresses

Primary practice location

621 Jefferson Davis Hwy Ste 201
Fredericksburg, VA 22401-4567

Mailing address

9527 Evergreen Cir
Fredericksburg, VA 22407-9225
Phone (703) 409-3417

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220725001878 VA Practitioner - Nurse Practitioner 8628459435 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1200 Sam Perry Blvd
Fredericksburg, VA 22401-4456
Phone (540) 741-3900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024183705VAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mary Washington Healthcare Physicians CurrentSince May 6, 2022 Accepting new patients
Mary Washington Healthcare Physicians CurrentSince May 6, 2022 Accepting new patients
Fredericksburg OBGYN Center Inc PastSince Feb 24, 2022 Accepting new patients

Locations

1001 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 741-1100

1200 Sam Perry Blvd
Fredericksburg, VA 22401
Phone (540) 372-3900

621 Emancipation Hwy
Ste 201
Fredericksburg, VA 22401
Phone (540) 372-2028

Interoperability endpoints

  • Direct secure messaging: jholder95153@marywashingtonhealthcare.direct-ci.com

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1644796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1447905856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9527 EVERGREEN CIR",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224079225",
            "telephone_number": "703-409-3417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "621 JEFFERSON DAVIS HWY STE 201",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224014567",
            "telephone_number": "540-372-2028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLDER",
        "first_name": "JAMIE",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-14",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "VA",
            "license": "0024183705",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fredericksburg, VA

Sources for this page

Verify at the official NPI Registry.