Basic Information
| Provider Information | |||||||||
| NPI: | 1164009908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHORTT | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSN, FNP-C, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 345 PLEASANT VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | CEDAR BLUFF | ||||||||
| State: | VA | ||||||||
| PostalCode: | 246098718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2769704907 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3997 BECKLEY RD | ||||||||
| Address2: | |||||||||
| City: | PRINCETON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 247407660 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044315499 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2021 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 108778 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.