Individual
JESSICA M LISK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AG-ACNP
Contact information
Practice address
1204 W MAIN ST, CHARLOTTESVILLE, VA 22903-2824
(434) 924-9119
Mailing address
PO BOX 749112, ATLANTA, GA 30374-9112
(434) 295-1000
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
0024188126
VA
2080P0202X
Pediatric Cardiology Physician
0024188126
VA
363LA2100X
Acute Care Nurse Practitioner
Primary
0024188126
VA
Other
Enumeration date
09/20/2023
Last updated
06/26/2025
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