Individual
JESSICA LYNN BLAKELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-3582
Mailing address
6440 RED BLUFF LN, IDAHO FALLS, ID 83406-5094
(808) 457-6088
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
0001273947
VA
363LA2100X
Acute Care Nurse Practitioner
0024184777
VA
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
10037
GU
363LF0000X
Family Nurse Practitioner
10037
GU
Other
Enumeration date
05/06/2022
Last updated
01/15/2025
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