Provider Demographics
NPI:1073374690
Name:WORTH, JESSICA HELEN
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:HELEN
Last Name:WORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:HELEN
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8681 W STAR CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-6243
Mailing Address - Country:US
Mailing Address - Phone:503-505-0973
Mailing Address - Fax:
Practice Address - Street 1:8681 W STAR CIR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-6243
Practice Address - Country:US
Practice Address - Phone:503-505-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program