Retro Medical LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024166865 Issued in VA

Legal business name

RETRO MEDICAL LLC

Practice address

5241 Balboa Dr
Virginia Beach, VA 23464-2641

Phone

(757) 348-4736

Fax

(757) 279-7090

NPI assigned

Apr 27, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Jennifer L Fellman, FNP-C

Title

Owner

Phone

(757) 348-4736

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1398556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398556800000",
    "number": "1508286725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5241 BALBOA DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234642641",
            "telephone_number": "757-348-4736",
            "fax_number": "757-279-7090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5241 BALBOA DR",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234642641",
            "telephone_number": "757-348-4736",
            "fax_number": "757-279-7090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETRO MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-27",
        "last_updated": "2014-04-27",
        "status": "A",
        "authorized_official_last_name": "FELLMAN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-348-4736",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024166865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI FOR DR JENNIFER FELLMAN",
            "identifier": "1316982457",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Restorative Psychotherapy & Wellness LLC
• Restorative Therapy Company LLC
• Restore Counseling & Wellness, LLC
• Restored Minds Counseling Group Inc.
• Restoring Waters Counseling LLC
• Bradley Reuter
• Rica Reuyan
• Revati Home Care LLC
• Yvette Revils
• Revive Aesthetics & Wellness

• Family Nurse Practitioner in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2014; 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.