Provider Demographics
NPI:1083444632
Name:JETT, BRIANNA SHELTON (FNP-C)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:SHELTON
Last Name:JETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:SHELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:332 MCCARTY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-5709
Mailing Address - Country:US
Mailing Address - Phone:540-419-7839
Mailing Address - Fax:
Practice Address - Street 1:121 COURTHOUSE LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:VA
Practice Address - Zip Code:22427-9336
Practice Address - Country:US
Practice Address - Phone:804-633-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAF01250466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily