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Individual

MRS. JESSICA LOUISE PORTER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PNP-PC

Contact information

Practice address
6355 WALKER LN STE 401, ALEXANDRIA, VA 22310-3250
(703) 924-2100
Mailing address
6355 WALKER LN STE 401, ALEXANDRIA, VA 22310-3250

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001303524
VA
163W00000X
Registered Nurse
RN1040218
DC
363LP0200X
Pediatric Nurse Practitioner
Primary
0024185704
VA

Other

Enumeration date
03/22/2021
Last updated
12/02/2022
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