Provider Demographics
NPI:1487306478
Name:JENNISON, KAELIN (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:KAELIN
Middle Name:
Last Name:JENNISON
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 PARK ST SE STE 300
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4653
Mailing Address - Country:US
Mailing Address - Phone:703-255-9100
Mailing Address - Fax:703-255-3457
Practice Address - Street 1:115 PARK ST SE STE 300
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4653
Practice Address - Country:US
Practice Address - Phone:703-255-9100
Practice Address - Fax:703-255-3457
Is Sole Proprietor?:No
Enumeration Date:2022-01-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001280015163W00000X
VA0024187529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse