Individual
JENNIFER N BOHANON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2232 WILBORN AVE, SUITE A, SOUTH BOSTON, VA 24592-1662
(434) 572-8977
(434) 572-2510
Mailing address
PO BOX 1115, SOUTH BOSTON, VA 24592-1115
(434) 517-3515
(434) 572-4549
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001842
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P00167510
—
VA
Enumeration date
08/01/2006
Last updated
12/11/2023
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