Provider Demographics
NPI:1285652057
Name:HUNDLEY, JAN L (CNS)
Entity type:Individual
Prefix:MRS
First Name:JAN
Middle Name:L
Last Name:HUNDLEY
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:BOYDTON
Mailing Address - State:VA
Mailing Address - Zip Code:23917
Mailing Address - Country:US
Mailing Address - Phone:434-738-0055
Mailing Address - Fax:434-738-0055
Practice Address - Street 1:1237 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BOYDTON
Practice Address - State:VA
Practice Address - Zip Code:23917
Practice Address - Country:US
Practice Address - Phone:434-738-0055
Practice Address - Fax:434-738-0055
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000286364SP0807X
NC552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5510040Medicaid
VA106480OtherANTHEM BCBS
VA5510040Medicaid