NPI 1023701927

Jared Waters

Practitioner Physician Assistant Roanoke, VA

Practice location

Address: 5673 Airport Rd, Roanoke, VA 24012-1119
Phone: (540) 523-8080
Mailing address: 3111 Grayland Ave, Richmond, VA 23221-3527

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 0110009479 (VA)

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Registry record

NPI: 1023701927
Entity type: Individual
Sex (as registered): Male
NPI issued: 29 May 2023
Record last updated: 17 Aug 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.