Individual provider Active NPI

Jessica Harley, FNP-C

  • Family Nurse Practitioner
  • Fairfax, VA
National Provider Identifier
1871052282
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0024178915 Issued in VA
Practice address
4400 University Dr
Fairfax, VA 22030-4444
Phone
(703) 993-2831
NPI assigned
Mar 15, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 1-120744 AL
Registered Nurse 163W00000X R221853 MD
Registered Nurse 163W00000X RN1020126 DC
Nurse Practitioner 363L00000X R221853 MD
Nurse Practitioner 363L00000X 1-120744 AL
Family Nurse Practitioner 363LF0000X 0024178915 VA Primary

Addresses

Primary practice location

4400 University Dr
Fairfax, VA 22030-4444

Mailing address

4400 University Dr
Fairfax, VA 22030-4444
Phone (703) 993-2835

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
I20200410001621 VA Practitioner - Nurse Practitioner 9436588571 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN1020126DCMDRegistered Nurse
R221853MDMDRegistered Nurse
1-120744ALMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Emergency Physicians PC CurrentSince Mar 1, 2020 Accepting new patients
Commonwealth Emergency Physicians PC Nurse Practitioner PastSince Apr 17, 2020 Accepting new patients

Locations

44045 Riverside Pkwy
Leesburg, VA 20176
Phone (703) 858-6040

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1552608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1871052282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 UNIVERSITY DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304444",
            "telephone_number": "703-993-2835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 UNIVERSITY DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220304444",
            "telephone_number": "703-993-2831"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARLEY",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-15",
        "last_updated": "2022-08-02",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-120744",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MD",
            "license": "R221853",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "DC",
            "license": "RN1020126",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MD",
            "license": "R221853",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-120744",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024178915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

Verify at the official NPI Registry.