Provider Demographics
NPI:1386688505
Name:BETTENHAUSEN, JESSEKA REE (FNP-C)
Entity type:Individual
Prefix:
First Name:JESSEKA
Middle Name:REE
Last Name:BETTENHAUSEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 ELKTON FARM RD
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-3878
Mailing Address - Country:US
Mailing Address - Phone:434-946-9565
Mailing Address - Fax:
Practice Address - Street 1:1710 WHITFIELD DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1401
Practice Address - Country:US
Practice Address - Phone:540-586-8889
Practice Address - Fax:540-586-8717
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004460363LF0000X
VA24138418363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK48027Medicare UPIN
ILK48028Medicare UPIN