Provider Demographics
NPI:1023907391
Name:SHOCK, JESSICA LYNN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:SHOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 196
Mailing Address - Street 2:
Mailing Address - City:STRYKER
Mailing Address - State:OH
Mailing Address - Zip Code:43557-0196
Mailing Address - Country:US
Mailing Address - Phone:419-630-3941
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 196
Practice Address - Street 2:
Practice Address - City:STRYKER
Practice Address - State:OH
Practice Address - Zip Code:43557-0196
Practice Address - Country:US
Practice Address - Phone:419-630-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide