Individual
JENNY WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 ELM AVE SE, ROANOKE, VA 24013-2222
(540) 985-8552
(540) 985-8518
Mailing address
213 S JEFFERSON ST STE 1006, ROANOKE, VA 24011-1713
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024178837
VA
363LF0000X
Family Nurse Practitioner
Primary
0024178837
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000
NOT APPLICABLE
—
Enumeration date
05/20/2020
Last updated
01/26/2026
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