Jacqueline L Webb, PNP
Individual provider Active NPI Pediatric Nurse Practitioner · Laurel Fork, VA
NPI 1457355299 · NPPES record last updated Feb 27, 2024
Key facts
- NPI
- 1457355299
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 0024134336 (VA)
- Practice address
- 14558 Danville Pike
Laurel Fork, VA 24352-3982 - Phone
- (276) 398-2292
- Fax
- (273) 398-3331
- NPI assigned
- Jun 9, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101122000263 | VA | Practitioner - Pediatric Medicine | 3274729934 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri Area Community Health | Current | Accepting new patients | |
| Tri Area Community Health | Current |
Accepting new patients | |
| Tri Area Community Health | Current |
Accepting new patients | |
| Tri Area Community Health | Past | Accepting new patients |
Locations
14559 Danville Pike
Laurel Fork, VA 24352
Phone (276) 398-2292
14558 Danville Pike
Laurel Fork, VA 24352
Phone (276) 398-1200
Interoperability endpoints
- jacqueline.webb@tachc.eclinicaldirectplus.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 0024134336 | VA | Yes |
Addresses
Primary practice location
14558 Danville Pike
Laurel Fork, VA 24352-3982
Mailing address
PO Box 9
Laurel Fork, VA 24352-0009
Phone (276) 398-1200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 007608942 | Medicaid | VA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | wedonotuse |
Other providers in Laurel Fork, VA
- Glen Edward Tate
- Tri Area Community Health
- Tri Area Community Health
- Tri Area Community Health
- Tri Area Community Health
- Anna W Wright
All providers in Laurel Fork, VA · Pediatric Nurse Practitioner in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.