Provider Demographics
NPI:1023360864
Name:DAILEY, JESSICA A (CNP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:A
Last Name:DAILEY
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 N CABLE RD
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45805-2133
Mailing Address - Country:US
Mailing Address - Phone:419-228-2600
Mailing Address - Fax:419-228-1100
Practice Address - Street 1:512 N CABLE RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45805-2133
Practice Address - Country:US
Practice Address - Phone:419-228-2600
Practice Address - Fax:419-228-1100
Is Sole Proprietor?:No
Enumeration Date:2012-10-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA13857-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0087128Medicaid
OH0087128Medicaid