Provider Demographics
NPI:1174889679
Name:BERNENS, JESSICA LYNNE (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:BERNENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1024 CENTERBROOKE LN STE F PMB 412
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8294
Mailing Address - Country:US
Mailing Address - Phone:757-337-4018
Mailing Address - Fax:757-337-4019
Practice Address - Street 1:5833 HARBOUR VIEW BLVD STE B
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3760
Practice Address - Country:US
Practice Address - Phone:757-337-4018
Practice Address - Fax:757-337-4019
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101258826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine